Outcomes of Traumatic Arterial Injuries in Upper vs. Lower Extremities

Outcomes of Traumatic Arterial Injuries in Upper vs. Lower Extremities

The purpose of this study is to identify and compare the causes of vascular trauma at the extremities, injury characteristics, types of vascular surgical interventions, and the outcomes of traumatic vascular injuries between the upper and lower extremities.

1. Primary patient assessment Patients will be clinically assessed on presentation, and resuscitation protocols will be initiated if signs of hypovolemic shock are present according to Advanced Trauma Life Support guidelines.

2. History and physical examination are the most important components of the diagnostic protocol The presence of hard signs of arterial injury

   • Absent or diminished pulses
   • Active haemorrhage
   • Large, expanding, or pulsatile hematoma
   • Bruit or thrill
   • Distal ischemia is considered an indication for surgery, and no further specific investigative measures will be taken.

   Soft signs of vascular trauma should be noted as well including

   • Small, stable hematoma
   • Unexplained hypotension
   • History of haemorrhage that is no longer present
   • Proximity of injury to major vessels

3. Investigations including:

   • The use of a hand-held Doppler examination as a diagnostic aid
   • Duplex US and CTA for imaging.
   • Lab investigations: Complete blood picture, Coagulation profile and Kidney function tests.

Options of intervention:

All vascular trauma patients will be admitted for operative management and follow up. The specific surgical intervention will be determined by the vascular surgeon according to type, site, and extent of the injury, ranging from ligation of the injured vessel to vascular graft interposition.

An injury to a peripheral artery that does not result in complete transection can be repaired depending on luminal diameter with an interrupted or continuous suturing technique. A complete transection of a peripheral artery is first managed with minimal debridement back to healthy intima at both ends then an end-to-end anastomosis or with an interposition graft of autogenous vein or prosthetics arterial graft.

Inclusion Criteria:

• All peripheral arterial injuries of one or more of the extremities.

Exclusion Criteria:

• Vascular injuries limited to the venous system only.
• Vascular injuries limited to thoracic, abdominal, or neck vessels.