Vascular Surgery Role in Vascular Trauma: 11-year Analysis of Peripheral Vascular Trauma Management at a Level-1 Trauma Center
Sundeep Guliani, Robin Osofsky, Shannen Ramey, Andrew Fisher, Richard Miskimins, Ross Clark, Mohammed Ali Rana
University of New Mexico, albuquerque, NM
INTRODUCTION: Vascular surgeons are increasingly relied upon in the management of complex peripheral vascular trauma. The degree however that vascular surgery (VS) is involved in vascular trauma care is not well established. We hypothesize that VS consultation is required in a high portion of complex lower extremity vascular trauma.
METHODS: A single-center retrospective review of all consecutive patients who sustained traumatic arterial injury of the lower extremity requiring open operative repair at a level-1 trauma center (from February 2009 to May 2020) was performed. Patients who underwent surgical repair were stratified by service that performed the operation (VS vs trauma surgery). Secondary outcomes assessed included location of arterial injury, type of repair, and clinical outcomes.
RESULTS: A total of 111 patients underwent operative repair of lower extremity arterial injury (mean age 34.5 ± 15.5 years, 89% male). The most common vessels requiring intervention were the superficial femoral artery (n=42, 38%), popliteal artery (n=35, 31.5%), and tibial vessels (n=19, 17.1%), The most common intervention required in patients was autologous bypass (n=85, 76.5%), followed by ligation (n=9, 8.1%), and primary repair (n=6, 5.4%). Majority of interventions overall required VS (n = 95 [86%]) involvement. VS performed a high proportion of the autologous bypass procedures compared to trauma surgery (n=79, 92.9% vs n=6, 7.1%). VS case load overall was likewise predominantly autologous bypass (n=79/95, 83.2%). Trauma surgery operated on a higher proportion of injures to the tibial vessels (44% vs 13%, p = 0.01), whereas vascular surgeons intervened more frequently on popliteal injuries (36% vs 6%, p = 0.02). With regard to method of arterial repair, trauma surgery was more likely to perform ligation (38% vs 3 %, p < 0.001) or primary repair (13% vs 3%, p = 0.04) compared to VS. However, vascular surgeons were more likely to perform repair with autologous graft (83% vs 38%, p < 0.001). There were no significant differences in rates of mortality, limb loss, transfusions requirement, fasciotomy, deep venous thrombosis (DVT), hematoma formation, or length of stay (LOS) between groups. Though, surgical site infections were more common in the trauma group (38% vs 15%, p = 0.04).
CONCLUSIONS:Vascular surgeons play a large role in management of complex lower extremity vascular trauma. In particular, vascular surgeons remain integral for management of more difficult injuries (eg. popliteal injuries) and are more likely to provide more complex repairs (eg. autologous grafts).
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