Kapilan G and Arudchelvam J*
Department of Vascular and Transplant Surgery, National Hospital of Sri Lanka, Sri LankaFulltext PDF
Introduction: Spasm of arteries result from contraction of the smooth muscles in the arterial media results in transient distal ischemia following trauma. This causes diagnostic dilemma. This study presents a series of lower limb arterial spasms following trauma. Methods: This is a prospective study of patients admitted to the National Hospital of Sri Lanka Colombo (NHSL) with lower limb arterial injuries for five months duration. The arterial spasm was diagnosed if the pulse was absent or of low volume in the injured limb and; The pulse reappeared after a period of observation or Angiography demonstration spasm was demonstrated or Visual confirmation of spasm on surgical exploration. Confirmed arterial injuries (e.g. on surgical exploration or on angiography), mangled limbs, compartment syndrome and patients with hemodynamic instability were excluded. All others who did not undergo surgical exploration underwent angiography confirmation of arterial spasm. Results: 18 patients with arterial spasm were included. 16 (88.9%) were males. Median age was 27.5 years (13 to 70). The causes of injuries were road traffic accidents in 17 (94.4%) and iatrogenic in one. There were 9 (50%) tibia, 5 (27.8%) popliteal, 2 femoral and 2 iliac artery spasms. All had fractures or joint injuries or underwent a joint intervention. 3 (16.7%) patients underwent exploration and Fogarty dilatation of the arteries. In all patients the distal pulses appeared following a period of observation or after surgical exploration. Conclusion: This study shows that young males are prone to develop spasms following trauma especially in tibial and popliteal arteries. Confirmation of spasm with more angiographies will help to avoid unnecessary surgical explorations.
Kapilan G, Arudchelvam J. Post- Traumatic Lower Limb Arterial Spasm: A Common Entity and an Important Cause for Diagnostic Dilemma: A Case Series. Ann Short Reports. 2020; 3: 1057.