Upper limb arterial injuries: experience of 713 patients and analysis of risk factors associated with limb loss

Abstract

Abstract Background Experience of upper limb arterial injury management was analysed and risk factors associated with limb loss were identified. Methods Between 1987 and 1997, data on 713 patients with 760 upper limb arterial injuries were analysed retrospectively. Results The mechanism of injury was stabbing in 52 per cent, gunshot in 23 per cent, blunt trauma in 14 per cent and shotgun in 5 per cent. The most frequently injured vessel was the brachial artery (53 per cent) followed by the axillary (20 per cent), subclavian (14 per cent), radial (7 per cent) and ulnar (6 per cent) arteries. Associated injuries included bony injury in 12 per cent, nerve injury in 39 per cent and remote injury affecting the head, chest or abdomen in 3 per cent. Surgical revascularization was carried out in 95 per cent of patients and arm fasciotomy was necessary in 9 per cent. The limb salvage rate for this series was 96 per cent (27 amputations) and the survival rate was 98 per cent (11 deaths). On stepwise logistic regression analysis, significant (P < 0·01) independent risk factors for amputation were blocked graft (odds ratio (OR) 7·6), tense compartment at presentation (OR 6·5), neurological deficit at presentation (OR 5·4) and associated compound fracture (OR 5·4). Conclusion Despite good collateral circulation, upper limb arterial injuries carry a considerable risk of limb loss, particularly when associated with soft tissue damage.