Traumatic Vascular Injuries in Low-and-Middle Income Countries: A Systematic Review and Meta-Analysis of Outcomes

Trauma induced vascular injuries constitute a significant cause of morbidity and mortality in low- and middle-income countries (LMICs) where access to prompt and specialized care is often limited. Understanding the patterns, management strategies, and outcomes of vascular injuries in these settings is needed to improve care delivery in this setting. This systematic review aims to synthesize current evidence on vascular trauma in LMICs, highlighting injury patterns, treatment approaches, and patient outcomes.

A systematic search was conducted using databases including PubMed, Scopus, and Embase for studies published between 2000 and 2025. Studies were included if they reported vascular injuries in LMICs and provided data on clinical presentation, management, or outcomes. Data was extracted on patient demographics, injury mechanisms, management strategies, and outcomes following trauma and pooled for meta-analysis using the Mantel-Haenszel method.

The literature search yielded 4,189 articles, of which 22 met inclusion criteria, reporting on 2,918 patients with vascular injuries. Injury mechanisms were predominantly penetrating (approximately 50-60%), most commonly due to gunshot and stab wounds, while blunt trauma (about 30-40%) was primarily related to road traffic accidents and falls. The mean age ranged from 26 to 44.8 years, with most patients in their third and fourth decades. Open surgical repair was the dominant approach, while endovascular techniques were increasingly applied in recent years. Total mortality ranged 0-15%, usually linked to polytrauma or thoracic vessel injury. Limb loss varied widely (2.8-59%), highest with delayed presentation (>6-8 hours) and popliteal artery injury. Early revascularization following injury yielded the best outcomes, with limb salvage rates exceeding 90% in several series, though outcomes were poorer in LMICs. Complications were frequent, most common being wound infections (≤23%).

Despite efforts at surgical and endovascular management of vascular injuries in LMICs, outcomes are often hindered by systemic limitations such as late presentation and limited resources. These results suggest that access to care in limited-resource settings is a significant factor to optimizing vascular trauma outcomes. Future research will focus on studying care access, studying trauma protocols in local hospitals, surveying regional trauma registries, and encouraging cost-effective models of vascular trauma care.