Year Book: Venous Injury: To Repair or Ligate, the Dilemma

1988 Year Book of Plastic and Reconstructive Surgery. Article 3-31. Timberlake-Gregory-A. OConnell-Ruary-C. Kerstein-Morris-D. Original Article: J. Vasc. Surg. 1986 Dec. 4. pp 553-558. Surgical management of major venous injuries is controversial with regard to ligation as opposed to repair. A retrospective review was made of medical records of 184 patients who had sustained isolated venous vascular injuries. Forty-three patients had only venous injury; 72 per cent underwent ligation. Injury was caused by penetrating *trauma* in all cases. The remaining 141 patients had both *arterial* and venous injury, the origin being blunt or penetrating *trauma;* 83 per cent had ligation. Injured were the inferior vena cava and the iliac, femoral, popliteal, distal leg, and arm veins. Surgical exploration was done in all patients. *Arterial* injuries were repaired by end-to-end or lateral arteriorrhaphy or by reversed saphenous vein interposition grafts. Venous injuries were ligated or repaired by end-to-end or lateral phleborrhaphy. Adjunctive fasciotomy was used when indicated clinically in 32 patients. The follow-up period ranged from 1 month to 9 years. There were no permanent sequelae of venous injury ligation. Transient edema, which resolved within 2-12 weeks, developed in 31 patients regardless of whether vein ligation or repair was performed. No extremity was lost. This study supports the concept that venous injury repair is not mandatory for limb salvage or prevention of long-term morbidity. Success with vein ligation is attributed to appropriate use of fasciotomy and conservative limb management. Postsurgical limb elevation appeared to prevent long-term disability in patients with lower extremity venous injury. Yet, despite successful vein ligation in the popliteal system, most evidence supports an aggressive approach to venous repair. Selective management reflecting the mechanism of injury, blood loss, anesthetic requirements, and injury to other organs may mitigate against extensive venous repair and for vein ligation as a viable alternative.