Ultrasound in Early Diagnosis of Combat Gunshot Vascular Injury of the Lower Extremities
E.K. Gavrilov, F.I. Zokhrabov, Г. Г. Хубулава
Abstract
Objective. To study combat gunshot vascular injuries of the lower extremities in early period using ultrasound data. Material and methods. The results of ultrasound were retrospectively assessed in 347 wounded with combat gunshot trauma of the lower extremities. All ones were at the advanced stage of providing early specialized medical care between May 01, 2022 and September 01, 2022 during special military operation on the territory of Donbass. All wounded were men aged 32.7±8.8 years. Mean period after injury was 257.8±109.3 min. Ultrasound of the main arteries and veins of the lower extremities was carried out using stationary and portable scanners in triplex mode (B-mode, color Doppler scanning mode, pulse Doppler mode) with linear (8—10 MHz) and, if necessary, convex (3—5 MHz) sensors. Results. Combat gunshot vascular injury of the lower extremities was detected in 29 (8.4%) people. Signs of arterial damage (lateral wound or intersection) were the most common within 4-6 hours after injury (23 (79.3%) people). Moreover, 21 (72.4%) ones had combined damage to the main arteries and veins of the lower extremities. In most cases of arterial rupture, popliteal artery or tibioperoneal trunk lesion was the most common (17 wounded, 58.6%). The most common vascular injury was concomitant damage to popliteal artery/tibioperoneal trunk with damage and segmental thrombosis of popliteal vein and/or tibial veins and/or venous sinuses of legs (15 wounded, 51.8%). We proposed the original method for ultrasound diagnosis of arterial rupture in gunshot wounds of the lower extremities. Thrombotic damage to the great vessels was noted in 27 (93.1%) patients. This lesion was segmental in the vast majority of cases and accompanied arterial and/or venous interruption. In the absence of direct arterial damage, thrombosis of the main arteries of the lower extremities was detected in 2 (6.9%) wounded, thrombosis of deep veins — in 1 (3.4%) patient. Conclusion. Arterial break (lateral wound or intersection of the main arteries) is the most common combat gunshot vascular injury of the lower extremities in early period of traumatic disease. Combined mechanical damage to the main arteries and veins of the lower extremities is the second common pattern. A few patients have primary contusion-induced thrombotic damage to the great vessels of the lower extremities without direct lesion in early period after injury.