Immediate Versus Delayed Repair for Lower Extremity Arterial Injury: A Propensity Score-Matched Analysis

Delayed repair is often used for lower extremity arterial injuries, typically following temporary intravascular shunting. However, supporting evidence remains limited. We hypothesized that delayed repair is not associated with inferior outcomes compared to immediate repair.

Adult patients (aged ≥16 y) undergoing open lower extremity vascular repair between 2017 and 2021 were identified using the Trauma Quality Improvement Project database. Repairs performed within 4 h of arrival were classified as immediate, whereas those performed thereafter were considered delayed. Cohorts were propensity score matched on demographics, injury mechanism, admission vital signs, transfusion requirements, and injury severity. Multivariable logistic regression was used to evaluate mortality and postoperative complications.

After matching, 165 immediate and 165 delayed repairs were analyzed. Delayed repair was associated with higher odds of compartment syndrome (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.1-6.0, P = 0.04), amputation (OR 1.9, 95% CI 1.0-3.6, P < 0.05), and mortality (OR 3.6, 95% CI 1.3-11.8, P = 0.02). Among patients with isolated injuries, delayed repair was associated with significantly higher odds of amputation (OR 3.7, 95% CI 1.4-10.9, P = 0.01). Within the blunt trauma subgroup, delayed repair was associated with both a higher median injury severity score (22 versus 13, P = 0.02) and significantly increased mortality (18.8% versus 3.5%, P < 0.01).

Delayed repair is associated with greater morbidity and mortality. These results appear to be driven by blunt trauma, although this subgroup is limited by residual confounding. When feasible, these findings support immediate definitive revascularization as the preferred approach.