Aetiology and Management of Vascular Injuries in Extremity Trauma: An Observational Study

Abstract

Introduction: Management of peripheral vascular injury is a challenging task. To save life and to salvage the limb, early diagnosis and prompt intervention is required. Aim: To analyse the cause of injury, surgical approach, outcome and complications in patients with peripheral vascular trauma. Materials and Methods: This observational study assessed 60 consecutive patients who were operated for peripheral vascular injuries in the last one and half year (October 2018 to March 2020). Diagnostic tools were clinical examination in combination with vascular Doppler. Vascular repair with interposition autologous vein graft or primary repair was performed. Extensive injury with non-viable limb requiring primary amputation was excluded from the study. The primary outcome in form of limb salvage was selected. Fisher-exact test was used to analyse limb salvage rate between two groups having median revascularisation time less than six hours and more than six hours. Results: In the present study there were 55 male patients (91.6%) out of 60 patients. The mean age was 24.8±7.0 years. The mechanism of injury in 28 (46.6%) cases was blunt trauma and in 32 (53.3%) cases it was penetrating trauma. The associated orthopaedic injury was present in 20 (33.3%) patients. The most commonly injured artery was brachial 26 (43.3%) followed by popliteal 13 (21.6%) and femoral artery nine (15%). Primary repair was performed in 18 (30%) cases and interposition vein graft in 42 (70%) cases. Majority of patients, 53 cases (88.3%) had functional viable limb. Complications found were wound infection in six cases (10%), revision surgery in five cases (8.3%) and secondary amputation in seven cases (11.6%). Median time interval between injury and revascularisation surgery was 9.04 hours. Those who presenting late (>6 hours) had a higher amputation rate but it was not statistically significant. Conclusion: Management of vascular injuries require prompt localisation and early surgical intervention. A successful outcome is seen in patients who were early diagnosed. However, limb salvation is possible, even in patients with delayed presentation.