RR30. Long-term Clinical Outcome and Functional Status after Arterial Reconstruction in Upper Extremity Injury

Abstract

To analyze long-term outcome including functional status in patients after arterial repair of civilian upper limb injury in our institution. This was a retrospective data analysis. All consecutive patients who had undergone repair of arterial lesions in the upper limb during the past two decades in our institution were included. Patients′ records were reviewed for demographic parameters, mechanism of injury, location of arterial lesion, presence of concomitant injuries (nerve, bone, and/or joint), and details of arterial repair. Clinical follow-up studies were performed. End points were long-term patency and long-term functional status using the Disabilities of Arm, Shoulder and Hand Questionnaire (DASH). A total of 117 arterial repairs were performed in 108 patients (87 male; median age, 35.7 years). Blunt trauma was the predominant cause of injury (n = 96 [82%]). Accompanying lesions of nerves (n = 39 [36%]) and/or orthopedic injuries (n = 65 [60%]) were present in 84 patients (78%). After a median follow-up time of 5.3 years (range, 0.5-19.7 years), 65 patients (60% of 108) were re-investigated. Long-term patency was 97%. Significant long-term functional impairment, as measured by the DASH questionnaire, was frequently seen, and determined by concomitant neurologic injury (DASH scores with neurologic lesion: 43.2 ± 31.4 vs without: 10.2 ± 21.1; P < .001) and ischemia at time of injury (DASH scores with ischemia: 31.4 ± 34.4 vs no ischemia: 14.4 ± 22.4; P < .05). Patients with injuries to the subclavian or axillary artery had higher disability than patients with brachial or forearm arterial injuries. On the other hand, DASH scores were independent of gender, age, and side of injury. Excellent long-term patency rates after arterial repair in upper extremity injuries can be achieved. Long-term functional impairment is a significant problem and determined by the associated neurologic injury as well as ischemia present at time of injury.