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Thu Nov 29 00:57:45 GMT 2007

I agree with K. none of us were there.? We also do not know if? he had any "down time" from blood loss. he may have had wonderful surgery to repair leg but irreverable neurologic compromise from low flow.? It sounds like he got a large amout of blood. We also do not know the caliber of vessle that was injured. we just had an ak47 take out both femurs in a young man during a "business deal".? Luckily he had no vascular injury, but both femurs are missing several inches.? I would hate to have seen what it would have looked like if a vessle was injured

RW

-----Original Message-----
From: KMATTOX at aol.com
To: trauma-list at trauma.org
Sent: Wed, 28 Nov 2007 4:45 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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Femoral Artery Injury