Femoral Artery Injury

[meredith mcbride]

I've seen a death occur from isolated femoral triangle penetrating injury. Larger vessel injury aside, when the profunda branches have been destroyed deep within muscular beds, the bleeding is nearly impossible to localize and control. Especially in a large patient with massive musculature, as you indicate. Irreversible shock can result from seemingly reasonable attempts for limb salvage when blood losses are unabated and ongoing. 

Tough case.



----- Original Message ----
From: "KMATTOX at aol.com" <KMATTOX at aol.com>
To: trauma-list at trauma.org
Sent: Wednesday, November 28, 2007 1:45:01 PM
Subject: Femoral Artery Injury

It is no secret to this list server that a VIP NFL football player has died  
this week of a GSW to the femoral artery.  ALL information I  list here I 
have read on the internet and have NO insider information from  anyone at the 
trauma center, family or other sources.  I am aware of  several trauma and 
vascular surgeons who have been called by the press, several  of whom have given 
information which did not match the printed information AND  some of the 
comments were politically motivated, such as, "an injury such as  this should have 
been treated by a board certified vascular  surgery."  and "Of course one might 
consider use of endovascular  techniques to control and repair this vascular 
injury."      There is too little information to support either of these  
statements.  However, I start the discussion with the information   that is known. 
    Quite honestly I was appauled by some of  the speculation and comments 
made by some physicians that I read, non of whom  were present.    There but 
for the grace of God are each of  us.    At any time we may receive a highly 
visible  patient.    

A 24 yom sustained a GSW from a burglar to his groin, hitting the femoral  
artery (status of nerve and vein not known).  He is taken to a Level   I trauma 
center by ambulance and taken to the operating room.  He  underwent 11 hours 
of surgery the details of which are  unknown.    He received significant 
blood  transfusions.    He was taken to the ICU in critical condition,   where he 
died the next day.    

Injury to the Femoral artery from a single GSW do not usually result in   such 
early death.    GSW to the femoral artery can be  complex.  It might be at 
the bifurcation of the common, superficial,  and profundi, and complex 
reconstruction is then required.  Damage  control use of temporary stents has been 
often applied in recent years with the  stent from the common femoral (or 
external iliac) to the superficial femoral,  and reconstruction of the injured area 
and profundi femoris the next day when  the patient is more stable.      
Complex injuries to  the femoral vein are often ligated, rather than attempting a 
complex venous  repair, and this is done for a long list of  reasons.      
Should there be acute thrombosis or  breakdown of a suture line in the ICU, a 
stat takeback to the OR is  indicated.  

I have seen delayed death secondary to a dying leg from complex combined  
femoral artery and vein and nerve injury (such as from a SGW), but not such an  
early death except from a couple of circumstances.  

I have seen HYPERACUTE and fatal pulmonary emboli at the time of femoral  
vein occlusion or ligation secondary to trauma.  I have also seen   fatal 
pulmonary emboli from a ligated femoral vein, even in people on Lovenox   and leg 
squeezers.      I would not be surprised  if this VIP did not die from a fatal 
pulmonary  embolus.      However, speculation is not in order,  this discussion 
is merely to focus on the kinds of injuries we all see  relatively frequently. 
  

One thing to consider in this patient that is DIFFERENT from the cases most  
of us see.  This was a well conditioned athelete.    His muscle mass was 
tremendous and dissection would have been more difficult  than what we normally 
encounter.        

One thing that I do know.  The surgeons at the trauma center to  which he 
was taken are very experienced and respected.  I would trust  their judgement 
to do the right thing and would support their option to exercise   whatever 
judgement is necessary.  

k



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