Title: Single-center Experience With Surgical Management of Upper Extremity Traumatic Vascular Injuries
Abstract: Upper extremity vascular injuries, although not frequent, can have an impact on patient's quality of life and carry significant morbidity in trauma patients. This study aims to evaluate clinical outcomes associated with operative management of upper extremity vascular trauma. Patients with upper extremity vascular injuries presenting to our Level 1 trauma center from 2016 to 2022 were identified from trauma database registry. Patients with nonvascular injuries and nontraumatic upper extremity injuries were excluded. Mechanisms of injury, anatomical distribution of vascular injury, types of vascular repair, clinical outcomes, and rates of limb loss were retrospectively analyzed in patients requiring operative vascular interventions. A total of 74 patients with upper extremity vascular injuries were identified, with 60 patients (81%) undergoing operative management. The majority of patients had penetrating traumas (85%), and the average age was 39 ± 17 years, with a higher proportion of men (75%). Psychiatric issues, including substance abuse, were the most common comorbidity (30%). Bypasses (18), primary vessel repairs (17), vessel ligations (15), explorations (6), mangled extremity amputations (3), and isolated thrombectomies (1) were the index operative interventions. Upper arm interposition axillary-axillary, axillary-brachial or brachial-brachial bypasses were performed in 67% (12/18) of bypass cases, with great saphenous vein (58%) and cephalic vein (25%) being the most commonly used conduits. The primary patency rate for these bypasses was 91.7% at 30 days and 1 year. Overall, 7% (4) of patients required major amputation and 10% (6) underwent minor amputation. The causes of amputations were revision of traumatic amputation (8%), infection (2%), and revascularization failure (7%). All revascularization failures were associated with hand digit or forearm vessel revascularizations, resulting in minor amputations. In-hospital mortality was 1.7% (1/60). Amputation-free survival rates at 30-days, 1 year, and 3 years were 83.3%, 81.5%, and 78.9%, respectively. In a civilian Level 1 trauma center, operative management of upper extremity vascular injuries resulted in favorable outcomes, with high primary bypass patency rates for upper arm revascularizations and acceptable overall amputation-free survival rates. These results help enhance clinical decision-making for these challenging injuries.