Management and Outcomes after Upper Versus Lower Extremity Vascular Trauma

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Orthopedic Surgery

Background:

• Limited literature exists on upper extremity vascular injuries compared to lower extremities.
• Current management protocols for upper extremity vascular trauma are often extrapolated from lower extremity data.
• This study aims to compare the management and outcomes of upper versus lower extremity traumatic vascular injuries using a large patient cohort.

Purpose of the Study:

• To compare the management strategies and patient outcomes for traumatic vascular injuries affecting the upper extremities versus the lower extremities.
• To identify differences in injury characteristics, operative techniques, and postoperative results between upper and lower extremity vascular trauma.
• To provide evidence-based insights for optimizing the clinical management of upper extremity vascular injuries.

Main Methods:

• A retrospective review of a level I trauma center's registry identified patients who underwent operative repair for traumatic vascular injuries.
• Data collected included demographics, injury mechanisms, surgical techniques, and patient outcomes from 2011 to 2019.
• Comparative analysis was performed between patients with upper extremity injuries and those with lower extremity injuries.

Main Results:

• Of 535 patients, 234 had upper extremity vascular injuries. Upper extremity injuries were more common in females and associated with pre-hospital tourniquet use, nerve injuries, and bleeding, but less with fractures.
• Operative management differed, with upper extremity injuries more likely to undergo vessel ligation or primary reanastomosis and less likely to require fasciotomies.
• Postoperatively, upper extremity injuries showed higher rates of persistent nerve deficits, while lower extremity injuries had a greater incidence of 30-day limb loss. Mortality and graft patency were similar.

Conclusions:

• Upper extremity vascular trauma presents with a lower risk of limb loss but a higher prevalence of neurological deficits compared to lower extremity injuries.
• Intraoperative identification of associated nerve injuries is crucial for improving functional outcomes post-vascular trauma.
• Clinical suspicion and targeted assessment for nerve involvement are paramount in managing upper extremity vascular trauma.