Management of upper limb vascular injuries and their outcomes-our experience from a level I trauma centre

Abstract

Introduction: Upper limb arterial trauma is associated with significant morbidity and functional impairment. Despite the critical role of timely intervention, we often encounter delayed presentations due to poor access to vascular surgery services and long travel times to the hospital. We analyzed the patterns of vascular injury encountered in our experience and gauged the impact of time delay and the nature of injury on our post-surgical outcomes.

Methods: We conducted a retrospective observational study of patients undergoing intervention for upper extremity arterial injuries at our vascular surgery department from 2020-2021. Patients presenting with a primary traumatic amputation or a non-salvageable ischemic hand defined according to the Rutherford classification of acute limb ischemia Grade III were excluded. Data regarding their demography, presentation, surgical interventions, and outcomes were gathered.

Results: 69 cases of upper extremity vascular trauma were included. The limb salvage rate was 94%, and the mortality rate was 0%. Higher Rutherford ischemia classes and more excellent MESS scores are associated with more excellent limb loss rates. Associated soft tissue injury also led to a higher rate of limb loss; while coexisting fractures or neurological injuries had no significant impact on salvage rates. Limb salvage was comparable to ligation and revascularization in brachial and radial injuries.

Conclusion: Upper-limb arterial injuries have a good prognosis if presented early to a vascular surgery centre. Our experience has yielded promising results with repair via native venous graft. Ligation of distal arteries is also possible owing to good collateral circulation.

Keywords: Extremity trauma; Upper limb; Vascular injury.