Late complications of arrow and spear wounds to the head and neck

Traumatic penetrating arteriovenous fistulas: a collective review

INTRODUCTION

Traumatic penetrating arteriovenous fistulas (AVFs) are very rare. The majority of these injuries occur secondary to penetrating trauma. Objectives of this study: review their incidence, clinical presentation, radiologic identification, management, complications and outcomes.

METHODS

A literature search was performed on MEDLINE Complete-Pubmed from 1829-2019. PRISMA guidelines were utilized. Of 305 potentially eligible articles, 201 articles were selected.

INCLUSION CRITERIA

patients age ≥ 18, articles with title and abstract in English, AVFs secondary to penetrating trauma, articles which specified vessels involved in AVFs, and those reporting complete information on patient presentation, diagnosis, imaging, surgical and/or endovascular surgical management, and outcomes of penetrating AVF's.

EXCLUSION CRITERIA

articles reporting blunt or iatrogenic AVFs, pediatric patients, fistulas used for dialysis and their complications, articles lacking complete information, cranial/spinal AVFs or cardiac AVFs, and duplicate articles. Mechanism of injury (MOI), diagnosis, involved vessels, management and outcomes of patients with AVFs secondary to penetrating trauma were recorded.

RESULTS

There were a total of 291 patients with AVFs secondary to penetrating injuries. Mechanism of injury (MOI): stab wounds (SW)-126 (43.3%), Gunshot wounds (GSW)-94 (32.3%), miscellaneous-35 (12%), mechanism unspecified-36 (12.4%). Anatomic area: neck-69 (23.7%) patients, thorax-46 (15.8%), abdomen-87 (30%), upper and lower extremities-89 (30.6%). Most commonly involved vessels-vertebral artery-38 (13%), popliteal vein-32 (11.7%). Angiography was diagnostic-265 patients (91.1%).

INTERVENTIONS

Surgical- 202 (59.6%), Endovascular-118 (34.8%). Associated: aneurysms/pseudoaneurysms-129 (44.3%).

CONCLUSION

Most AVFs occur secondary to penetrating injuries. Stab wounds account for the majority of these injuries. Most frequently injured vessels are vertebral artery and superficial femoral vein. Surgical interventions are the most common mode of management followed by endovascular surgical techniques.

Penetrating arrow injuries in Western India

BACKGROUND

Though penetrating arrow injuries are a rarity in the West, they are still seen frequently among the tribal population of India. This study was performed with the aim of documenting the clinical profile of injuries caused by arrows, the varied modes of clinical presentation and their management at a university hospital.

METHODS

A retrospective study of indoor records of 70 patients admitted over a period of 5 years at the Sir Sayajirao General Hospital (SSGH), Baroda, Gujarat, India, was carried out.

RESULTS

A majority of patients were males (n=67), the median age being 36 years. The median delay in presentation to the hospital was 11 h. Median TRISS score was 98.2%. There were three mortalities. Major wound infection (n=1), intestinal fistula (n=1) and multiple organ dysfunction syndrome (n=2) were the noteworthy complications.

CONCLUSION

Arrow injury and its astute management is still relevant in this century. Delay in treatment and a poor TRISS score adversely affects survival. Optimal exploration, adequate mobilisation, minimising haemorrhage and repair are the building blocks of successful treatment.