TRA 2. Factors Affecting Management and Limb Salvage in Upper Limb Vascular Trauma: A Prospective Study of 52 Cases in a Tertiary Care Center

Abstract

Upper limb vascular trauma, although less common than vascular trauma in the lower limbs, is steadily increasing in numbers because of the increase in road traffic accidents and workplace injuries. It poses a significant cause of morbidity and has an impact on quality of life compared with lower limb injuries. A prospective study was done to see the factors affecting the type of management and limb salvage in our institute. Study was done from December 2017 to January 2019. A total of 52 patients presenting with upper limb vascular injuries were included. Patients were evaluated by demographics, mode of injury, duration, type of injury, management, and surgical procedures. Limb ischemia at the time of presentation was classified according to Rutherford acute limb ischemia classification. Based on the clinical and radiologic findings, patients were managed surgically or conservatively. Mean age at presentation was 27.3 ± 16.5 years (range, 2-65 years), and children <15 years represented 23% (12). Male patients outnumbered female patients with a ratio of 3.7:1. Median time to presentation was 12 hours. Blunt injury was the most common type (69%), followed by penetrating (25%) and crush injury (6%). The most common mode of injury was roadside accident in 53%, followed by fall from height (13.5%). Most patients had grade IIb ischemia (65%). Two patients presented with grade III ischemia and underwent primary amputation. The right side was more common (52%). There were no bilateral injuries or associated lower limb injuries. The brachial artery was most commonly involved (69%); the axillary artery was involved in (13%). Multilevel injury of both brachial and forearm arteries was present in (5.7%). Types of arterial injury included transection (32%), contusion (19%), and thrombosis (17%); 67% of patients had associated fractures, most commonly shaft humerus (48%), and 21% had nerve injuries. Twenty-five percent of patients were managed conservatively with antiplatelets and anticoagulation. Among the patients undergoing surgery, reverse saphenous vein grafting was the most commonly performed procedure (38.5%), followed by thrombectomy (16.5%) and end-to-end anastomosis (13.5%). One patient underwent secondary amputation. The 1-month limb salvage rate was 94.2%. There was no significant correlation of time of injury, artery involved, and associated bone or nerve injury with the type of management and outcomes. Patients aged <15 years underwent fewer fasciotomies and were more likely to be managed conservatively (P < .001). Upper limb vascular injuries can be dealt with by surgery or by conservative management in a select group of patients, especially children <15 years, with good limb salvage rates.