Outcomes Comparison Between Ligation and Repair after Major Lower Extremity Venous Injury

The necessity of repair remains controversial after major lower extremity venous injuries (MLEVIs). Ligation may cause venous hypertension which should be managed with fasciotomies. Previous studies have shown that fasciotomy rate is not affected by the type of management of MLEVIs. The aim of this study was to examine the rate of fasciotomy, amputation, and other complications from a difference between ligation and repair of MLEVIs.

The National Trauma Data Bank (NTDB) for 2010-2014 was reviewed. Eligible patients were restricted to MLEVI patients who underwent surgical ligation or repair. Data on demographics, rate of fasciotomy, secondary amputation, and other complications were collected. Comparative analysis between ligation and repair on demographics, complications, and outcomes was performed using multivariate logistic regression models.

A total of 2120 patients were identified in NTDB and 1029 (48.5%) underwent ligation while 1091 (51.5%) underwent repair. The overall rate of fasciotomy and secondary amputation was 38.9% (n = 824) and 4.8% (n = 101), respectively. Patients in the ligation group had a higher proportion of university hospital setting and penetrating injury. Otherwise, there was no significant difference in other characteristics between the 2 groups. Patients in the ligation group had significantly higher rates of fasciotomy and secondary amputation and longer hospital length of stay (LOS) than those in the repair group (44.6% vs. 33.5%, risk ratio [RR] 1.33, 6.1% vs. 3.4%, RR 1.81, 11 [6-20] vs. 9 [5-17], respectively). Otherwise, there was no significant difference in all other complications and in-hospital mortality between 2 groups.

The fasciotomy rate was surprisingly high and affected by venous ligation in patients with MLEVIs. Considering the overall physiological condition, trauma surgeons should perform venous repair aggressively and prepare judiciously for fasciotomy after surgery. Avoiding venous ligation and maintaining venous outflow may contribute to not only reducing the need for fasciotomy and LOS but also saving limbs.