Highlights
- •Vascular surgeons are involved in increasing numbers of lower extremity arterial traumas.
- •High proportions of complex arterial repairs require vascular surgery assistance.
- •Collaboration between trauma and vascular surgeons is increasingly common.
- •There is a potential future benefit in developing collaborative models of care.
Background
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 the service that performed the operation (VS versus
trauma surgery [TS]). 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 an autologous
bypass (n = 85, 76.5%), followed by ligation (n = 9, 8.1%) and primary repair (n = 6, 5.4%). Most interventions overall required VS involvement (n = 95, 86%). VS performed a higher proportion of autologous graft procedures compared
to TS (n = 79, 92.9% vs. n = 6, 7.1%). VS case load overall was likewise predominantly autologous grafts (n = 79/95, 83.2%). TS operated on a higher proportion of injuries to the tibial vessels
(44% vs. 13%, P = 0.01), whereas VS intervened more frequently on popliteal injuries (36% vs. 6%,
P = 0.02). With regard to the method of arterial repair, TS 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, VS was 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, hematoma formation,
or length of stay between groups. Although, surgical site infections were more common
in the TS group (38% vs. 15%, P = 0.04).
Conclusions
Vascular surgeons play a large role in managing complex lower extremity vascular trauma.
In particular, VS remains integral for the management of more difficult injuries (e.g.,
popliteal injuries) and is more likely to provide more complex repairs (e.g., autologous
grafts).
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Article info
Publication history
Published online: February 16, 2023
Accepted:
January 26,
2023
Received:
November 14,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Meeting Name: Southern Association for Vascular Surgery Annual Meeting January 19–22, 2022, Manalapan, Florida.
Conflict of interest: The authors have no relevant disclosures.
Author contributions: Conception and design: R.O., S.R., M.A.R., and S.G.; Analysis and interpretation: R.O., H.H., R.M., R.C., and S.G.; Date collection: R.O., P.M., R.C., and S.G.; Writing Manuscript: R.O., H.H., R.C., and S.G.; Critical revision: R.O., H.H., P.M., S.R., R.M., R.C., M.A.R., and S.G.; Approval of manuscript: R.O., H.H., P.M., S.R., R.M., R.C., M.A.R., and S.G.; Agreement to be accountable: R.O., H.H., P.M., S.R., R.M., R.C., M.A.R., and S.G.; Statistical Analysis: R.O., H.H., R.M., and S.G. All authors have read and agreed to the published version of the manuscript.
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