The dissertation aims at improving the treatment of victims with traumatic arterial injuries (TAI) by investigating the etiology, pathogenesis, clinical course, pathomorphological changes in blood vessels, diagnostics and treatment of patients of a wide age range (from infants to the elderly). The work is based on the analysis of the results of examination and treatment of 222 victims of TAI, aged 9 days to 84 years, median 32.0 years, interquartile age (21 years; 71 years). For the analysis of the age aspects of TAI the classification of age according to V. Quinn (1994) is chosen. According to this age classification, the victims were divided into seven groups: I (infants, ≤2 years, n = 9, 4.05%), II (early childhood, 3-6 years, n = 2 , 0.9%), III (childhood, 7-12 years, n = 9, 4.05%), IV (adolescence, 13-18 years, n = 25, 11.3%), V (young adults, 19-40 years, n = 108, 48.6%), VI (mature, 41-65 years, n = 55, 24.8%), VII (elderly, ≥66 years, n = 14, 6.3%). The causes of injuries differed between different age groups (p <0.01), but the distribution of penetrating and blunt injuries (p = 0.6), as well as the prevalence of different types of TAI among victims of different ages was the same (p = 0.6). Clinical diagnosis without the use of instrumental methods is less commonly used in adolescents (p <0.01) and more often in adults (p <0.01). Hard and soft TAI symptoms were observed with equal frequency in children and adults (p = 0.5). For adolescents and adults, there has been an increase in the use of ultrasound from 25.1 ± 4.0% in previous decades (1992-2000, 2001-2010) to 68.0 ± 4.0% in the last decade (2011-2019) (p <0.05). In contrast, when TAI was suspected in young children, physicians consulted ultrasound equally frequently (68.2 ± 9.9%) during both the previous and the last decade of hospitalization (p = 0.5). In the context of the widespread use of ultrasound to assess arterial blood flow, a method of ultrasound determination of volumetric arterial blood flow to the extremities after TAI has been proposed. The developed technique allowed to demonstrate the degree of reduction of arterial blood supply quantitatively, in comparison with the intact limb, both in children and adults. Catheterization angiography and non-catheterization angiography were used equally often among children and adults (p = 0.2). The age category to which the victim belonged influenced the decision of physicians to choose the treatment method. This conclusion was obtained by comparative analysis (p <0.01) and confirmed by regression analysis. Differences in treatment found for children of groups I and II, who were most often treated conservatively - in 88.9 ± 10.5% (p <0.01) and 50.0% (95% CI 0.9-99.2%) ( p <0.01), respectively. The proportions of different operations (ligation, repair, end-to-end anastomosis and replacement) did not differ between the victims of different groups (p = 0.07). Venous grafts were used for arterial replacement in 92.3±3.2% and synthetic grafts in 7.4±3.2% of children and adults (p = 0.7). Early complications were detected in 11.7±2.2% of patients. According to comparative and regression analyzes, among the factors (age category, mechanism and etiology of injury, topography, type of TAI, time from trauma to hospitalization, decade of hospitalization, prehospital diagnostic errors, type of treatment and atherosclerosis) age category did not increase the risk of complications (p = 0.5).
