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ABSTRACT
Introduction. Les traumatismes vasculaires constituent des urgences chirurgicales extrêmes dont le pronostic dépend de la précocité de la revascularisation. En Afrique subsaharienne, et particulièrement au Cameroun, les données sur ces lésions restent fragmentaires malgré une violence interpersonnelle croissante. Cette étude visait à analyser le profil épidémiologique, les modalités thérapeutiques et les facteurs associés au pronostic des plaies artérielles traumatiques dans deux hôpitaux de référence à Yaoundé. Méthodologie. Nous avons mené une étude transversale descriptive incluant tous les patients traités pour une plaie artérielle traumatique à l’Hôpital Central et à l’Hôpital Général de Yaoundé entre janvier 2022 et décembre 2024. Le diagnostic reposait principalement sur l'examen clinique (signes durs et mous), complété par l'angioscanner ou l'échodoppler en cas de stabilité hémodynamique. La stratégie chirurgicale privilégiait la suture latérale ou l'anastomose après embolectomie systématique à la sonde de Fogarty. Résultats. L’échantillon comprenait 88 patients, majoritairement des hommes (80,7 %) avec un âge moyen de 33,1 ans. Les agressions par arme blanche (55,7 %) et les accidents de la voie publique (20,5 %) constituaient les principaux mécanismes. Les lésions siégeaient préférentiellement sur l’artère fémorale superficielle (19,3 %) et l'artère ulnaire (17 %), couvrant plus des trois quarts des cas avec les atteintes de l'avant-bras et de la cuisse. Le délai moyen de prise en charge était de 16 ± 29 heures. La suture latérale fut le geste le plus fréquent (44,3 %). Le taux de sauvetage de membre a atteint 85,2 %, malgré un taux d’amputation global de 14,8 % et une mortalité de 6,8 %. Un délai d'admission supérieur à six heures était significativement associé au risque d'amputation (p < 0,001). Conclusion. Les plaies artérielles à Yaoundé touchent principalement l’homme jeune victime de violence. Bien que les techniques de réparation directe offrent des résultats satisfaisants, le retard de prise en charge demeure le principal obstacle au succès thérapeutique, imposant une optimisation des circuits d'urgence.
RÉSUMÉ
Introduction. Vascular trauma represents a critical surgical emergency where prognosis depends on the speed of revascularization. In Sub-Saharan Africa, particularly Cameroon, data on these injuries remain sparse despite rising interpersonal violence. This study aimed to analyze the epidemiological profile, therapeutic modalities, and factors associated with the prognosis of traumatic arterial injuries in two referral hospitals in Yaoundé. Methodology. We conducted a descriptive cross-sectional study including all patients treated for traumatic arterial injuries at the Yaoundé Central Hospital and Yaoundé General Hospital from January 2022 to December 2024. Diagnosis primarily relied on clinical examination (hard and soft signs), supplemented by CT angiography or Doppler ultrasound in hemodynamically stable cases. Surgical strategy prioritized lateral suture or end-to-end anastomosis following systematic Fogarty catheter embolectomy. Results. The sample comprised 88 patients, predominantly male (80.7%), with a mean age of 33.1 years. Sharp object assaults (55.7%) and road traffic accidents (20.5%) were the primary mechanisms. Lesions were mainly located in the superficial femoral artery (19.3%) and the ulnar artery (17%), which, together with upper arm and thigh injuries, accounted for over three-quarters of the cases. The mean time to management was 16 ± 29 hours. Lateral suture was the most common procedure (44.3%). The limb salvage rate reached 85.2%, despite an overall amputation rate of 14.8% and a mortality rate of 6.8%. An admission delay exceeding six hours was significantly associated with amputation risk (p < 0.001). Conclusion. Arterial injuries in Yaoundé primarily affect young men as victims of violence. While direct repair techniques yield satisfactory results, delayed management remains the main obstacle to therapeutic success, necessitating optimized emergency protocols.
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References
- 1. Mirdamadi, N., Bakhtiari, M., Baratloo, A., Fattahi, M.R. and Farshidmehr, P. (2022) An Epidemiologic Overview of Traumatic Vascular Injures in Emergency Department. A Retrospective Cross-Sectional Study. Archives of Academic Emergency Medicine, 10, e59
- 2. Alarhayem, A.Q., Cohn, S.M., Cantu-Nunez, O., Eastridge, B.J. and Rasmussen, T.E. (2019) Impact of Time to Repair on Outcomes in Patients with Lower Extremity Arterial Injuries. Journal of Vascular Surgery, 69, 1519-1523.
- 3. Gebregiorgis, D., Nega, B. and Seyoum, N. (2021) A Perspective of Extremity Vascular Trauma Epidemiology and Its Management in a Resource Limited Set Up. Clinical Surgery Research Communications, 5, 27-34.
- 4. Onakpoya, U.U., Eyekpegha, J.O., Ogunrombi, A., Ohuche, A.S. and Ojo, T.O. (2019) Pattern of Extremity Arterial Injury and Outcome of Repair in Southwest, Nigeria. Nigerian Journal of Surgery, 25, 85-90.
- 5. Adeoye, P.O., Salami, M.A., Oyemolade, L.A. and Adegboye, V.O. (2013) Civilian Vascular Injuries in an Urban African Referral Institution. East African Medical Journal, 90, 404-408.
- 6. Khan, F.H., Yousuf, K.M. and Bagwani, A.R. (2015) Vascular Injuries of the Extremities Are a Major Challenge in a Third World Country. Journal of Trauma Management & Outcomes, 9, 1-5.
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- 8. Nkomo, B.N.B., Michelle, D.A., Rawlings, N.D.S., Boris, A., Aristide, K.N.G., Calvin, M.G. and Joss, B.A.M.L. (2022) Aspects Épidémiologiques, Cliniques, Thérapeutiques et Évolutifs des Traumatismes Vasculaires des Membres Opérés au Centre des Urgences de Yaoundé. Health Sciences and Disease, 23, 68-72.
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- 10. Fokou, M., Chichom, M.A., Eyenga, V.C., Nguifo Ml, N.N.B., Bahebeck, J., Teyang, A. and Pagbe, J.J. (2011) Les traumatismes vasculaires périphériques en pratique civile: À propos de 41 lésions opérées au Cameroun. Chirurgie Thoracique Cardio-Vasculaire2011, 15, 145-149.
- 11. Krüger, A., Florido, C., Braunisch, A., Walther, E., Yilmaz, T.H. and Doll, D. (2013) Penetrating Arterial Trauma to the Limbs: Outcome of a Modified Protocol. World Journal of Emergency Surgery, 8, Article No. 51.
- 12. Hussein, A.M., Ali, A.A., Ahmed, S.A., Mohamud, M.F.Y., Ahmed, M.A.M. and Kizilay, M. (2024) Our Experience with Blast and Gunshot Induced Traumatic Vascular Injuries at Somalia’s Major Vascular Referral Center. Scientific Reports, 14, Article No. 13004.
- 13. Dieng Papa Adama, Diop Momar Sokhna, Gaye Magaye, et al. Vascular Traumatism of Limbs in Civil Practice in Dakar. Cardiol Vasc Res. 2018; 2(4)
- 14. Adeoye PO, Adebola SO, Adesiyun OAM, Braimoh KT. Peripheral vascular surgical procedures in Ilorin, Nigeria: indications and outcome. African Health Sciences 2011; 11(3): 433 – 437
- 15. Baghi Iraj, Herfatkar Mohammad Rasool, Shokrgozar Leila, Poor-Rasuli Zahra, and Aghajani Fatemeh. Assessment of Vascular Injuries and Reconstruction. Trauma Mon. 2015 November; 20(4): e30469.
- 16. Güven C, Kafadar H. Evaluation of extremity vascular injuries and treatment approaches. Niger J Clin Pract 2020;23:1221-8. Doi: 10.4103/njcp.njcp_656_18
- 17. Randimbinirina Z L, Rajaobelison T, Randrianarisoa F F, Ravalisoa M L A, Rakotoarisoa A J C. Plaies vasculaires périphériques post-traumatiques vues au Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo. Rev. Anesth.-Réanim. Med. Urg. Toxicol. 2018 (Janvier-Juin) ;10(1) : 1-4.
- 18. Doody O., Given M.F., Lyon S.M. Extremities Indications and techniques for treatment of extremity vascular injuries. Injury, Int. J. Care Injured (2008) 39, 1295—1303. doi : 10.1016/j.injury.2008.02.043
- 19. D’Alessio Ilenia, Domanin Maurizio, Bissacco Daniele, Romagnoli Silvia, Rimoldi Pierantonio, Sammartano Fabrizio, and Chiara Osvaldo. Operative Treatment and Clinical Outcomes in Peripheral Vascular Trauma: The Combined Experience of Two Centers in the Endovascular Era. Ann Vasc Surg 2020; 62: 342–348.
- 20. Kuwahara Jeffery T., Kord Ali, Ray, Jr Charles E. Penetrating Extremity Trauma Endovascular versus Open Repair? Semin Intervent Radiol 2020;37:55–61.
- 21. Weaver John J., Chick Jeffrey F.B., Monroe Eric J., Johnson Guy E. Life and Limb: Current Concepts in Endovascular Treatment of Extremity Trauma. Semin Intervent Radiol 2021;38:64–74.
- 22. Yangni-Angate H., Ayegnon G., Meneas C.H., Yapobi Y. and Kangah M. Arterial trauma of the extremities. An Ivorian surgical experience (Côte d’Ivoire). Nigerian Journal of Surgical Research. Vol 8 No1 2,2007: 49 53
- 23. Aduful H.K. and Hodasi W.M. Peripheral vascular injuries and their management in Accra. Ghana Medical Journal Volume 41, Number 4 PP 186-9
- 24. Ogunleye, Ezekiel Olayiwola; Olusoji, Olugbenga Oluseyi; Kanu, Okezie Obasi1. Vascular Injuries: Aetiology, Presentation and Management Outcomes at a Tertiary Hospital in Lagos, Nigeria. Nigerian Postgraduate Medical Journal 29(4):p 334-340, Oct–Dec 20
References
1. Mirdamadi, N., Bakhtiari, M., Baratloo, A., Fattahi, M.R. and Farshidmehr, P. (2022) An Epidemiologic Overview of Traumatic Vascular Injures in Emergency Department. A Retrospective Cross-Sectional Study. Archives of Academic Emergency Medicine, 10, e59
2. Alarhayem, A.Q., Cohn, S.M., Cantu-Nunez, O., Eastridge, B.J. and Rasmussen, T.E. (2019) Impact of Time to Repair on Outcomes in Patients with Lower Extremity Arterial Injuries. Journal of Vascular Surgery, 69, 1519-1523.
3. Gebregiorgis, D., Nega, B. and Seyoum, N. (2021) A Perspective of Extremity Vascular Trauma Epidemiology and Its Management in a Resource Limited Set Up. Clinical Surgery Research Communications, 5, 27-34.
4. Onakpoya, U.U., Eyekpegha, J.O., Ogunrombi, A., Ohuche, A.S. and Ojo, T.O. (2019) Pattern of Extremity Arterial Injury and Outcome of Repair in Southwest, Nigeria. Nigerian Journal of Surgery, 25, 85-90.
5. Adeoye, P.O., Salami, M.A., Oyemolade, L.A. and Adegboye, V.O. (2013) Civilian Vascular Injuries in an Urban African Referral Institution. East African Medical Journal, 90, 404-408.
6. Khan, F.H., Yousuf, K.M. and Bagwani, A.R. (2015) Vascular Injuries of the Extremities Are a Major Challenge in a Third World Country. Journal of Trauma Management & Outcomes, 9, 1-5.
7. Thakur, U.K., Savlania, A., Sahoo, S., Pandey, A., Sandeep, M. and Reddy, P.A. (2019) Lower Extremity Arterial Injuries: Impact of Time of Presentation, Type of Injury and Therapeutic Strategy with Limb Salvage at One Month. European Journal of Vascular and Endovascular Surgery, 58, e775-e776
8. Nkomo, B.N.B., Michelle, D.A., Rawlings, N.D.S., Boris, A., Aristide, K.N.G., Calvin, M.G. and Joss, B.A.M.L. (2022) Aspects Épidémiologiques, Cliniques, Thérapeutiques et Évolutifs des Traumatismes Vasculaires des Membres Opérés au Centre des Urgences de Yaoundé. Health Sciences and Disease, 23, 68-72.
9. Mampiadana, M.L., Raherinantenaina, F., Randimbinirina, Z.L., Rakotoarisoa, A.J.-C. and Rajaonanahary, T.M.A. (2024) Etiology and Surgical Management of Penetrating Arterial Trauma of Limbs in Toamasina. World Journal of Cardiovascular Surgery, 14, 181-190.
10. Fokou, M., Chichom, M.A., Eyenga, V.C., Nguifo Ml, N.N.B., Bahebeck, J., Teyang, A. and Pagbe, J.J. (2011) Les traumatismes vasculaires périphériques en pratique civile: À propos de 41 lésions opérées au Cameroun. Chirurgie Thoracique Cardio-Vasculaire2011, 15, 145-149.
11. Krüger, A., Florido, C., Braunisch, A., Walther, E., Yilmaz, T.H. and Doll, D. (2013) Penetrating Arterial Trauma to the Limbs: Outcome of a Modified Protocol. World Journal of Emergency Surgery, 8, Article No. 51.
12. Hussein, A.M., Ali, A.A., Ahmed, S.A., Mohamud, M.F.Y., Ahmed, M.A.M. and Kizilay, M. (2024) Our Experience with Blast and Gunshot Induced Traumatic Vascular Injuries at Somalia’s Major Vascular Referral Center. Scientific Reports, 14, Article No. 13004.
13. Dieng Papa Adama, Diop Momar Sokhna, Gaye Magaye, et al. Vascular Traumatism of Limbs in Civil Practice in Dakar. Cardiol Vasc Res. 2018; 2(4)
14. Adeoye PO, Adebola SO, Adesiyun OAM, Braimoh KT. Peripheral vascular surgical procedures in Ilorin, Nigeria: indications and outcome. African Health Sciences 2011; 11(3): 433 – 437
15. Baghi Iraj, Herfatkar Mohammad Rasool, Shokrgozar Leila, Poor-Rasuli Zahra, and Aghajani Fatemeh. Assessment of Vascular Injuries and Reconstruction. Trauma Mon. 2015 November; 20(4): e30469.
16. Güven C, Kafadar H. Evaluation of extremity vascular injuries and treatment approaches. Niger J Clin Pract 2020;23:1221-8. Doi: 10.4103/njcp.njcp_656_18
17. Randimbinirina Z L, Rajaobelison T, Randrianarisoa F F, Ravalisoa M L A, Rakotoarisoa A J C. Plaies vasculaires périphériques post-traumatiques vues au Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo. Rev. Anesth.-Réanim. Med. Urg. Toxicol. 2018 (Janvier-Juin) ;10(1) : 1-4.
18. Doody O., Given M.F., Lyon S.M. Extremities Indications and techniques for treatment of extremity vascular injuries. Injury, Int. J. Care Injured (2008) 39, 1295—1303. doi : 10.1016/j.injury.2008.02.043
19. D’Alessio Ilenia, Domanin Maurizio, Bissacco Daniele, Romagnoli Silvia, Rimoldi Pierantonio, Sammartano Fabrizio, and Chiara Osvaldo. Operative Treatment and Clinical Outcomes in Peripheral Vascular Trauma: The Combined Experience of Two Centers in the Endovascular Era. Ann Vasc Surg 2020; 62: 342–348.
20. Kuwahara Jeffery T., Kord Ali, Ray, Jr Charles E. Penetrating Extremity Trauma Endovascular versus Open Repair? Semin Intervent Radiol 2020;37:55–61.
21. Weaver John J., Chick Jeffrey F.B., Monroe Eric J., Johnson Guy E. Life and Limb: Current Concepts in Endovascular Treatment of Extremity Trauma. Semin Intervent Radiol 2021;38:64–74.
22. Yangni-Angate H., Ayegnon G., Meneas C.H., Yapobi Y. and Kangah M. Arterial trauma of the extremities. An Ivorian surgical experience (Côte d’Ivoire). Nigerian Journal of Surgical Research. Vol 8 No1 2,2007: 49 53
23. Aduful H.K. and Hodasi W.M. Peripheral vascular injuries and their management in Accra. Ghana Medical Journal Volume 41, Number 4 PP 186-9
24. Ogunleye, Ezekiel Olayiwola; Olusoji, Olugbenga Oluseyi; Kanu, Okezie Obasi1. Vascular Injuries: Aetiology, Presentation and Management Outcomes at a Tertiary Hospital in Lagos, Nigeria. Nigerian Postgraduate Medical Journal 29(4):p 334-340, Oct–Dec 20