Femoral Artery Injury

[Errington Thompson]

Some of the easiest and hardest cases that I have done have been femoral
artery injuries.  There are so many details that we just don't know.  How
long was he down?  What was his pressure at the scene?  What treatment did
he get in route?  Were the pre-hospital providers able to get control of the
bleeding in route with pressure?  Was the patient given massive amounts of
prehospital fluid?  Was he cold?  Did he become coagulopathic?  What was his
initial pH in the ER?  Did he go straight to the OR?  What were the
operative findings?  Was a shunt used?  Was heparin used?  Was mannitol
used?  Did he have any blood flow to his foot before surgery?  Did he
require fasciotomies?  How much blood, FFP and crystalloid were used?  What
did he look like post op?  

There are a whole host of questions that we can't answer.  Therefore, I have
refrained from commenting on his treatment.  I have commented on the
senseless violence that we take care of on a daily basis.  I have commented
on the lack of leadership that I have seen from community leaders and
national leaders.  Last New Year's Eve Darrant Williams of the Denver
Broncos was shot and killed.  It is time for minority communities to address
this problem.  

Finally, Sean Taylor was clearly wild and thuggish when he was drafted 4
years ago.  He had been arrested several times for various problems.
Recently however it seemed that he was turning his life around.  I don't
know this for a fact.  All I can do is go by press reports.  I applaud him
for trying to do the right thing.  I applaud his father for handling this
situation with poise and grace.  Senseless violence whether it is on an NFL
safety or a 16 yo from the streets leaves me feeling very empty and sad.  

Errington

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Author - Letter to America
Asheville, NC

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: Wednesday, November 28, 2007 4:45 PM
To: trauma-list at trauma.org
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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