Vascular Surgeon Presence and Protocolized Approach for Better Outcomes in Lower Extremity Vascular Trauma

Lower extremity vascular trauma could end in sequelae or death if inadequately managed. The majority of data comes from large databases with high heterogeneity among centers. This study reports the experience of a single urban referral center with a structured approach to vascular trauma.

Retrospective descriptive-analytical review of the trauma registry of a trauma center between 2018 and 2024. Patients with arterial or venous injuries who underwent intervention were included. Demographic, clinical, surgical, and trauma mechanism were described. The primary outcome was major amputation rate at 30 days, secondary outcomes were 30-day mortality, postoperative revascularization thrombosis (PRT) and complications.

A total of 89 patients, median age was 32 years, 92.1% were male, and 70.8% were penetrating traumas. Isolated arterial injuries accounted for 43.8%, isolated venous for 4.5% and combined for 51.7%. A vascular surgeon was present in 79.8%. Most frequently compromised arteries were the superficial femoral (37.6%), popliteal (34.1%), and tibial vessel (21.2%). Secondary major amputations at 30 days occurred in 7.1% of arterial lesions more frequent in popliteal trauma (P = 0.04). Thirty-day mortality was 3.3%. PRT (odds ratio [OR] 7.5, P = 0.021), orthopedic injury (OR 16.9, P = 0.006) and significant soft tissue injury (OR 8.44, P = 0.01) were significant risk factors for secondary major amputation. The presence of a vascular surgeon was protective for PRT (OR 0.06, P = 0.001).

Amputation rates were lower than the previously reported. Factors that may influence these outcomes are the follow of an institutional protocol and the presence of a vascular surgeon; poor outcomes were associated with soft tissue compromise, orthopedic injury, blunt trauma, and PRT.