Vascular Surgery Role in Vascular Trauma: 11-Year Analysis of Peripheral Vascular Trauma Management at a Level-1 Trauma Center

Abstract

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. 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. A total of 111 patients underwent operative repair of lower extremity arterial injury (mean age 34.5±15.5years, 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). 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).