The Outcomes of Delayed Revascularization in Lower Extremity Vascular Injury: A Retrospective Cohort Study

Area of Science:

• Vascular Surgery
• Trauma Surgery
• Reconstructive Surgery

Background:

• Delayed revascularization for lower extremity traumatic vascular injuries presents challenges due to potential reperfusion injury.
• Consensus on the efficacy of limb salvage procedures with ischemic times exceeding 6 hours remains elusive.

Purpose of the Study:

• To evaluate the outcomes of delayed revascularization in patients with lower extremity traumatic vascular injuries.
• To validate current treatment strategies and identify areas for improvement in limb salvage procedures.

Main Methods:

• Retrospective cohort study of 59 patients undergoing delayed revascularization for lower extremity traumatic vascular injuries (January 2008 - June 2018).
• Exclusion criteria included non-salvageable limbs, renal trauma, or ischemic times less than 6 hours.
• Data collected included demographics, vascular injury details, ischemia duration, Mangled Extremity Severity Score (MESS), and secondary amputation rates.

Main Results:

• The mean duration of ischemia was 14.1 hours, with 83.1% of patients having a MESS score of 7 or higher.
• A limb salvage rate of 89.8% was achieved, with only 12.2% requiring secondary amputations.
• Rhabdomyolysis occurred in 31 patients, with 6 requiring temporary renal replacement therapy (RRT), and only one needing lifelong RRT.

Conclusions:

• Delayed limb salvage procedures for lower extremity traumatic vascular injuries, even with ischemic times over 6 hours, should be attempted.
• Careful patient assessment can lead to high limb salvage rates, minimal renal complications, and acceptable functional outcomes.
• The study validates the effectiveness of delayed revascularization despite the risks of reperfusion injury.