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Citation
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Kim S, Schneider A, Raulli S, Ruiz C, Marston W, McGinigle KL, Wood J, Parodi FE, Farber MA, Pascarella L. J. Vasc. Surg. 2024; ePub(ePub): ePub. |
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Abstract
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OBJECTIVE: The modern treatments of trauma have changed in recent years. We aim to evaluate the factors associated with limb salvage and mortality after extremity arterial trauma, especially with respect to the type of conduit utilized in revascularization.
METHODS: The National Trauma Data Bank was queried to identify patients with upper and lower extremity (UE and LE) arterial injuries between 2016 - 2020. The patients were stratified by the types of arterial repair. The primary outcome was in-hospital mortality.
RESULTS: 8,780 patients were found with 5,054 (58%) UE and 3,726 (42%) LE injuries. Eighty-three percent were men, and the mean age was 34 ± 15 years. Penetrating mechanism was the predominant mode of injury in both UEs and LEs (73% and 67%, respectively) with a mean injury severity score (ISS) of 14 ± 8. For UEs, the majority underwent primary repair (67%, p<0.001), while the remainder received either a bypass (20%) or interposition graft (12%). However, LEs were more likely to receive a bypass (52%, p<0.00001) than primary repair or interposition graft (34% and 14%, respectively). Compared to the extremely low rates of amputation and mortality among UE patients (2% for both), LE injuries were more likely to result in both amputation (10%, p<0.001) and death (6%, p<0.001). Notably, compared to primary repair, use of a prosthetic conduit was associated with a 6.7-fold increase in risk of amputation in UE and 2.4-fold increase in LE (p<0.0001 for both). Synthetic bypasses were associated with a nearly 3-fold increase in return to the OR in UE bypasses (p<0.05) and a 2.4-fold increase in return to the OR in LE bypasses (p<0.0001).
CONCLUSIONS: In recent years, most extremity vascular trauma was due to penetrating injury with a substantial burden of morbidity and mortality. However, both limb salvage rates and survival rates have remained high. Overall, LE injuries more often led to amputation and mortality than UE injuries. The most frequently used bypass conduit was vein, which was associated with less risk of unplanned return to the OR and limb loss, corroborating current practice guidelines for extremity arterial trauma.
Language: en |