The Belfast approach to managing complex lower limb vascular injuries

Area of Science:

• Vascular Surgery
• Trauma Management
• Limb Salvage Surgery

Background:

• Complex lower limb vascular injuries (CLVIs) carry a high risk of amputation and systemic complications like SIRS and MODS.
• Historically, CLVI treatment focused on rapid arterial repair, often with suboptimal vein management, leading to poor outcomes.
• Ischaemia-reperfusion injury (IRI) is a significant contributor to limb loss in traumatic vascular injuries.

Purpose of the Study:

• To evaluate the impact of a policy change involving early intraluminal shunting for CLVIs.
• To compare outcomes before and after the implementation of a comprehensive, one-stage surgical approach.

Main Methods:

• Introduction of a new policy in 1979 at the Regional Vascular Surgery Unit, Royal Victoria Hospital, Belfast.
• The policy emphasizes early intraluminal shunting of both artery and vein in a disciplined, one-stage procedure.
• Data from the pre-shunt period (1969-1978) was compared with the post-shunt period (1979-2000).

Main Results:

• Early shunting of artery and vein significantly reduced the need for fasciotomy in both penetrating and blunt injuries (p=0.016, p=0.02).
• A significant decrease in the incidence of contracture was observed with early shunting (p=0.018, p=0.02).
• The policy led to a significant reduction in amputation rates for both penetrating and blunt CLVIs (p=0.009, p=0.012).

Conclusions:

• Early intraluminal shunting of both artery and vein in CLVIs offers substantial benefits.
• This policy improves patient outcomes, including reduced limb loss and fewer complications.
• The approach fosters better operative discipline and interspecialist collaboration.