Ligation Versus Repair of Isolated Traumatic Peripheral Venous Injury: A Systematic Review and Meta-Analysis

There are no guidelines to suggest repair versus ligation for traumatic deep venous injuries. We aimed to compare the outcomes after reconstruction versus ligation of isolated traumatic venous injuries. This systematic review and meta-analysis (PROSPERO Registration Number: CRD42019143136) included all literature reported on the management of isolated venous injuries in adult trauma patients, excluding case reports from 1950 to 2020. Primary outcomes were mortality and amputation, while compartment syndrome, chronic venous hypertension, deep venous thrombosis, and pulmonary embolism were the secondary outcomes. PubMed, Google Scholar, Cochrane database, and Web of Science were searched. Study selection and synthesis were done following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 25 studies were included. All the studies were observational, with the majority being retrospective in nature. Results of our meta-analysis show that ligation is significantly associated with higher rates of amputation (odds ratio [OR] = 1.73, 95% confidence interval [CI] = 1.20-2.48, p = 0.003) and mortality (OR = 1.50, 95% CI = 1.09-2.06, p = 0.01), whereas there is no significant difference in the rates of chronic venous insufficiency, deep venous thrombosis, and pulmonary embolism. There is insufficient data to analyze various types of venous repair, as well as to account for clinical severity at the time of presentation. Our results favor repair over ligation.