Management Of Vascular Trauma Research Articles

Association of rurality with short-term outcomes of peripheral vascular trauma

BackgroundPeripheral vascular trauma is a major contributing factor to long-term disability and mortality among patients with traumatic injuries. However, an analysis focusing on individuals at a high risk of experiencing limb loss due to rural and urban peripheral vascular trauma is lacking. MethodThis was a retrospective analysis of the 2016 to 2020 Nationwide Readmissions Database. Patients (≥18 years) undergoing open or endovascular procedures after admission for peripheral vascular trauma were identified using the 2016 to 2020 Nationwide Readmissions Database. Patients from rural regions were considered Rural, whereas the remainder comprised Urban. The primary outcome of the study was primary amputation. Multivariable regression models were developed to evaluate rurality with outcomes of interest. ResultsOf 29,083 patients, 4,486 (15.6%) were Rural. Rural were older (41 [28–59] vs 37 [27–54] years, P < .001), with a similar distribution of female sex (23.0 vs 21.3%, P = .09) and transfers from other facilities (2.8 vs 2.5%, P = .34). After adjustment, Rural status was not associated with the odds of mortality (P = .82), with urban as reference. Rural status was, however, associated with greater odds of limb amputation (adjusted odds ratio 1.85, 95% confidence interval 1.47–2.32) and reduced index hospitalization cost by $7,100 (95% confidence interval $3,500–10,800). Additionally, compared to patients from urban locations, rurality was associated with similar odds of non-home discharge and 30-day readmission. Over the study period, the marginal effect of rurality on the risk-adjusted rates of amputation significantly increased (P < .001). ConclusionPatients who undergo peripheral vascular trauma management in rural areas appear to increasingly exhibit a higher likelihood of amputation, with lower incremental costs and a lower risk of 30-day readmission. These findings underscore disparities in access to optimal trauma vascular care as well as limited resources in rural regions.

Peripheral vascular trauma - basic management, diagnosis and treatment.

Peripheral vascular injuries occur in 1-3% of all traumas in civilian settings. The management of these injuries is often based on experience derived from war medicine where these injuries are more common. The goal of this article is to summarize basic guidelines for the diagnosis and treatment of vascular injuries. Western Trauma Association (WTA) and Eastern Association for the Surgery of Trauma (EAST) both have their own guidelines for vascular trauma management. Vascular injuries occur both in penetrating and blunt traumas. Complete vessel disruption occurs more frequently in penetrating traumas. In the case of blunt trauma, intimal defects are more common, resulting in dissection, false aneurysm, or intramural hematoma. The limb is mostly endangered due to ischemia, reperfusion injury and the compartment syndrome. Prompt diagnosis and treatment are paramount. Vascular trauma management is part of the ATLS protocol and life-over-limb principle. The primary goal is to stop the massive external bleeding. Clinical examination and CT angiography are the most helpful for the diagnosis. Surgical revision is indicated when hard signs are present. This can be a damage control surgery with the primary goal to stop the bleeding as quickly as possible. A shunt can be used for temporary reperfusion of the limb. Definitive treatment can take the form of a simple suture, patches or graft interposition; both prosthetic and autologous grafts are used. Sufficient debridement and fasciotomy are important steps in the therapy. In some cases, endovascular treatment can be used. Over the last century, the treatment strategy changed dramatically. Data from recent military conflicts show a decrease in amputation rates, and limb salvage has become a standard.

Training in vascular trauma surgery for non-vascular surgeons: Vascular trauma surgery skills course.

The experience of general and trauma surgeons in vascular trauma management has decreased with sub-specialization of surgery and working hours restrictions. We introduce avascular trauma surgery skills course established to train German military surgeons prior to their deployment to conflict areas. The intention and implementation of the vascular trauma course for non-vascular surgeons is described in detail. In hands-on courses, participants learn and train basic vascular surgical techniques on more realistic extremity, neck, and abdominal models with pulsatile vessels. Afundamental and an advanced course each provide military as well as civilian surgeons from different non-vascular specialties with asurgical skill set including direct vessel sutures, patch angioplasty, anastomosis, thrombectomy, and resuscitative endovascular balloon occlusion of the aorta (REBOA) in order to render them capable of managing major vascular injuries. The experiences of this vascular trauma surgical skills course, initially established for military surgeons, can also be of use to all civilian general, visceral, and trauma surgeons occasionally facing traumatic or iatrogenic vascular injuries. Thus, the introduced vascular trauma course is valuable for all surgeons working in trauma centers.

Outcomes of vascular trauma associated with an evolution in the use of endovascular management

ObjectiveThe availability of endovascular techniques has led to a paradigm shift in the management of vascular injury. Although previous reports showed trends towards the increased use of catheter-based techniques, there have been no contemporary studies of practice patterns and how these approaches differ by anatomic distributions of injury. The objective of this study is to provide a temporal assessment of the use of endovascular techniques in the management of torso, junctional (subclavian, axillary, iliac), and extremity injury and to evaluate any association with survival and length of stay. MethodsThe American Association for the Surgery of Trauma (AAST) Prospective Observational Vascular Injury Treatment registry (PROOVIT) is the only large multicenter database focusing specifically on the management of vascular trauma. Patients in the AAST PROOVIT registry from 2013 to 2019 with arterial injuries were queried, and radial/ulnar, and tibial artery injuries were excluded. The primary aim was to evaluate the frequency in use of endovascular techniques over time and by body region. A secondary analysis evaluated the trends for junctional injuries and compared the mortality between those treated with open vs endovascular repair. ResultsOf the 3249 patients included, 76% were male, and overall treatment type was 42% nonoperative, 44% open, and 14% endovascular. Endovascular treatment increased an average of 2% per year from 2013 to 2019 (range, 17%-35%; R2 = .61). The use of endovascular techniques for junctional injuries increased by 5% per year (range, 33%-63%; R2 = .89). Endovascular treatment was more common for thoracic, abdominal, and cerebrovascular injuries, and least likely in upper and lower extremity injuries. Injury severity score was higher for patients receiving endovascular repair in every vascular bed except lower extremity. Endovascular repair was associated with significantly lower mortality than open repair for thoracic (5% vs 46%; P < .001) and abdominal injuries (15% vs 38%; P < .001). For junctional injuries, endovascular repair was associated with a non-statistically significant lower mortality (19% vs 29%; P = .099), despite higher injury severity score (25 vs 21; P = .003) compared with open repair. ConclusionsThe reported use of endovascular techniques within the PROOVIT registry increased more than 10% over a 6-year period. This increase was associated with improved survival, especially for patients with junctional vascular injuries. Practices and training programs should account for these changes by providing access to endovascular technologies and instruction in the catheter-based skill sets to optimize outcomes in the future.

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

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).

Brazilian guidelines on diagnosis and management of traumatic vascular injuries.

Trauma is a leading cause of death, permanent disability, and health care cost worldwide. The young and economically active are the most affected population. Exsanguination due to noncompressible torso hemorrhage is one of the most frequent causes of early death, posing a significant challenge to trauma and vascular surgeons. The possibility of limb loss due to vascular injuries must also be considered. In recent decades, the approach to vascular injuries has been significantly modified. Angiotomography has become the standard method for diagnosis, endovascular techniques are currently incorporated in treatment, and damage control, such as temporary shunts, is now the preferred approach for the patients sustaining physiological derangement. Despite the importance of this topic, few papers in the Brazilian literature have offered guidelines on vascular trauma. The Brazilian Society of Angiology and Vascular Surgery has developed Projetos Diretrizes (Guideline Projects), which includes this publication on vascular trauma. Since treating trauma patients is a multidisciplinary effort, the Brazilian Trauma Society (SBAIT) was invited to participate in this project. Members of both societies reviewed the literature on vascular trauma management and together wrote these guidelines on vascular injuries of neck, thorax, abdomen, and extremities.

Surgical Management of Vascular Trauma; A Systematic Review

Vascular trauma is a significant public health concern, and there have been numerous incidents globally in recent years. Peripheral vascular injuries, including axillobrachial and upper extremity branches, as well as femoropopliteal and lower limb branches, account for 40% to 75% of all vascular injuries. Our systemic review aimed to examine surgical management strategies for vascular trauma. Data sources included PubMed/Medline and Embase. Our review investigated English-language articles (from 2010 to 2023) according to the PRISMA guidelines. Overall, there were 7 articles. Surveys and analyses of national databases were the most widely used methods (n=7 studies). The search identified 777 studies, 7 were eligible for inclusion in the analysis. Further understanding of vascular trauma, and treatment protocols may help improve evaluation and management in the future. Our research covered a range of treatment options; the proportion of vascular injuries treated without surgery or utilizing endovascular techniques has increased. Individuals who receive medications intravenously, especially drug users, often present late in the course of their diseases and are notoriously difficult to treat. Despite the challenges in control, it is crucial to remain vigilant for vascular problems that might be fatal. Patient education and awareness may lead to the early detection and treatment of these diseases, which have high morbidity and mortality rates. Revascularization is necessary for limb salvage in patients with severe vascular damage. Simultaneous orthopedic injuries pose significant challenges and increase the risk of limb amputation. Multiple fractures and a MESS score of 6 indicate limited potential for limb salvage.

Upper Limb Vascular Traumas with Vascular Exposure: Difficulties of Reconstruction in an Isolated Cardiovascular Surgical Environment

Abstract Introduction and Objective: Advocate for the knowledge and development of intrahospital therapeutic management of vascular trauma with vascular exposure, in our working conditions. Materials and Methods: This was a descriptive retrospective study which covered the period from January 2015 to June 2022. It was carried out from the medical records of patients operated on for vascular trauma with exposure of the vessels, in the Cardiovascular Surgery Department at the Abidjan Heart Institute. The following data were studied: epidemiological data, anatomo-clinical characteristics, and therapeutic data. Results: Nine medical records of eight male and one female patient were collected. The average age of the patients was 36 years. Elementary vascular lesions were as follows: complete section of the brachial artery and vein (n = 3), loss of substance of the brachial artery (n = 2), contusion of the brachial artery (n = 1), lateral wound of the ulnar artery (n = 2), and complete section of the radial artery (n = 1). Revascularization consisted in a brachio-brachial arterial bypass using a great saphenous vein graft (n = 3), end-to-end, respectively, arterial and venous anastomosis (n = 3), direct suture of the ulnar artery (n = 2), and in a radio-radial end-to-end arterial anastomosis (n = 1). The covering flaps used were the biceps brachii brachial muscle pedicled flap (n = 6) and the pedicled fasciocutaneous inguinal flap of McGregor (n = 3). The immediate and short-term postoperative follow-up was simple in all patients with scars of good trophicity. Conclusion: The surgical treatment requires skills in plastic surgery for the cardiovascular surgeon or the joint participation, in an emergency, of the cardiovascular surgeon and the plastic surgeon or, if necessary, the management of the patient in two stages. This last therapeutic modality generates additional morbidities and financial cost for the patient.

General surgical unit experience of traumatic vascular injuries in an Australian regional hospital

Background: Vascular trauma is a significant burden to the regional community due to the associated high morbidity and mortality from the complications of the injuries. This may be due to the complexity of the injuries and the issues with initial management at the regional hospitals. Vascular injury management training should improve the outcome of initial surgical management by the general surgical team in regional centres. The study aims to describe the epidemiology and management of vascular injury in regional hospitals in Queensland, Australia.Methods: A retrospective descriptive analysis was performed using the data of patients with traumatic vascular injuries between January 2017 and July 2021 presented to Hervey Bay hospital in Queensland, Australia.Results: Fifty-nine patients with vascular injuries were reviewed. The reported number of penetrating and blunt trauma cases were 43 (72.9%) and 16 (27.1%) respectively, and 42 (71.2%) were males. Most mechanisms of injury were cuts (n=32, 54.2%), followed by falls (n=16, 27.1%) and stabs (n=11, 18.7%). Fifty-one (86.4%) were initially surgically managed regionally, with 21 (35.6%) requiring transfer to a tertiary trauma centre. Outcomes of the incidents resulted in one (1.7%) patient requiring amputation, three (5.1%) needing a fasciotomy and the mortality of two (3.4%) patients.Conclusions: Vascular trauma causes a significant burden to Australian regional hospitals. Identifying injury patterns and common causes for vascular injury will help in early identification and prompt management. Vascular trauma management training should improve the quality of care from the general surgeons in the regional centres.

Conservative Management in Lower Extremity Gunshot Injuries: A Ten-Year Experience

Indications for immediate operative exploration in vascular trauma have been well described in the literature. However, this indication is often blurred in cases where the patient has diminished but present pulses, or only single-vessel runoff in the injured lower extremity. Improvements in quality of computed tomography angiography (CTA) has allowed for an increase in conservative management of vascular trauma. The objective of this study was to examine outcomes at a tertiary level 1 trauma center to validate practices and confirm that conservative, nonoperative management of diminished runoff has safe outcomes, and additionally to identify areas for improvement in management.

A cadaveric perfused model with antegrade arteriovenous pulsatile circulation: a new tool for teaching endovascular skills.

Background:The benefits of using cadaveric humans in surgical training are well documented, and knowledge of the latest endovascular techniques is essential in the daily practice of vascular surgeons. Our study explores the feasibility of an affordable human cadaveric model with pulsatile and heated antegrade perfusion for reliable and reproducible endovascular or surgical simulation.Methods:We undertook cannulation of 7 human cadavers embalmed in a saturated salt solution to create a left-to-right central perfusion with a heated solution, from the ascending thoracic aorta to the right atrium. To that end, we used surgically created carotidojugular and femorofemoral arteriovenous fistulas. Biomedical engineers designed a prototype pump for pulsatile circulation. We monitored invasive blood pressure and temperature. We used this model for training for endovascular thoracic aortic procedures and open vascular surgeries.Results:The prototype pump achieved a pulsatile flow rate of 4.7 L/min. Effective cadaveric perfusion was achieved for several hours, not only with an arterioarterial pathway but also with arteriovenous circulation. The arterial pressures and in situ temperatures accurately restored vascular functions for life-like conditions. This new model made it possible to successfully perform thoracic endovascular aortic repair, subclavian artery stenting and simulation of abdominal open vascular trauma management. The saturated salt solution method and a specifically designed pump improved cost competitiveness.Conclusion:Endovascular simulation on human cadavers, optimized with the pulsatile and heated perfusion system, can be a dynamic adjunct for surgical training and familiarization with new devices. This reproducible teaching tool could be relevant in all surgery programs.

Managing Vascular Trauma: Trauma Surgeons versus Vascular Surgeons

Changes in vascular trauma care and trainee exposure to vascular surgery have raised questions regarding who should take care of vascular trauma patients. This study aimed to determine nationwide trends and perceptions regarding the management of vascular trauma amongst vascular and trauma surgeons. Online surveys were administered to trauma surgeons through the American Association for the Surgery of Trauma (AAST) and to vascular surgeons through the Vascular and Endovascular Surgery Society (VESS) and Western Vascular Society (WVS) in February 2021. Demographics, practice-related information, and interest in, experience and comfort level with vascular trauma were queried. Trainees and those practicing outside the United States were excluded. Results were analyzed using Stata/BE v16.1. 247 surgeons were included in the final study population, of which 163 (66%) were trauma surgeons (T) and 84 (34%) were vascular surgeons (V). Vascular surgeons were younger (46 v 51y, P < .001) and had fewer years in practice (10 v 17y, P < .001). Vascular surgeons had greater experience and comfort with managing vascular trauma, but less interest in both vascular and endovascular trauma care when compared to trauma surgeons. Inability to maintain skillset (27%) and unfamiliarity with techniques (32%) were the most common barriers to practicing vascular trauma cited by trauma surgeons. Despite significant interest in practicing vascular trauma amongst trauma surgeons compared to vascular surgeons, most feel unprepared to do so. Collaboration between vascular and trauma surgeons could close the experience gap and appeal to the interests of both groups.

Endovascular Instead of Open Surgical Repair of Axillosubclavian Artery Injuries: An Evolving Paradigm Shift

Axillosubclavian injuries (ASI) comprise a small proportion of vascular injuries, yet their morbidity and mortality is high. This is often attributable to non-compressible bleeding in the apical thorax, hemodynamic instability, and the anatomically challenging location of these vessels making them difficult to access and control quickly. While the traditional management of ASI was with open surgical repair (OSR), recent years have seen an evolution towards less invasive endovascular repair (EVR). In patients with these injuries, EVR may be a safer alternative that achieves similar immediate results with significantly lower complication and mortality rates than the highly morbid open surgical option. In this article, we review and compare the two approaches, providing an overview of patient selection, anatomic considerations, techniques, postoperative management, and outcomes. With the advent of EVTM and more trauma team members capable of endovascular management of vascular trauma, a paradigm shift towards EVR for ASI is taking place.

Management of vascular trauma across Canada: A cohort study with implications for practice

BackgroundThe aim of this study was to provide a description of vascular trauma and its management at trauma centers across Canada. MethodsThis retrospective cohort study evaluated patients from 8 Canadian level 1 trauma centers (2011–2015). Medical records were queried to identify adult patients who survived to hospital with major vascular injury. Major vascular injury was defined as injury to named arterial or venous vessels in the legs, arms torso, and neck. Data collected included patient demographics, injury mechanism, injury details, management and clinical outcomes. ResultsA total of 1330 patients were included. Patients were 76% male with a mean age of 43 (SD 18.8). Reported injuries were 63% blunt, 36% penetrating, and the remainder mixed. The most common specific mechanisms of injury were motor vehicle collision (36%), stabbing (26%), and falls (16%), with gunshot injuries accounting for <5%. Pre-hospital tourniquets were applied in 27 patients (2%). The mean Injury Severity Score (ISS) was 24 (SD 14.5). We identified injuries to named vessels of the neck (32%), thorax (23%), abdomen and pelvis (27%), upper extremity (14%) and lower extremity (10%). Specific vascular injuries included transection (50%), complete occlusion (11%), partial occlusion (39%), and pseudoaneurysm formation (11%). Injuries were managed non-operatively in 32%, with definitive open surgical management (24%), endovascular management (9%) and with damage control techniques in the operating room (3%). Amputation occurred in 10% of lower extremity and 5% of upper extremity injuries. Responsibility for vascular injury management was undertaken by a wide variety of specialists (n = 17). Overall, in-hospital mortality was 13%, and 2% of patients underwent amputation. ConclusionThis study describes the nature and management of vascular injuries across Canada. The variability in injury mechanisms, management strategies, specialty responsible for management, and outcomes have important implications for practice change and knowledge translation.

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

Vascular surgeons are increasingly relied upon in the management of complex peripheral vascular trauma. However, the degree to which 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.

Bioengineered Acellular Vessel Implantation in a Patient with Chronic Limb-Threatening Ischemia: A Case Report and Discussion of Implications for Trauma

The ideal conduit for vascular reconstruction is one that can be obtained “off the shelf” and demonstrates long-term patency, tissue incorporation and resistance to infection. Currently available conduits, such as autologous vein and synthetic grafts, are limited in one or more of these areas. The Human Acellular Vessel (HAV), a bioengineered, acellular blood vessel, can be obtained “off the shelf” and has shown promise in each of these properties. We describe a case in which the HAV was utilized for open bypass reconstruction in a patient with chronic limb-threatening ischemia who lacked alternative reconstructive options. The case is followed by a discussion of potential broader applications of this novel implant, specifically in the management of vascular trauma.

Addressing Contemporary Management of Vascular Trauma: Optimization of Patient Care Through Collaboration.

Addressing Contemporary Management of Vascular Trauma: Optimization of Patient Care Through Collaboration.

Trends and outcomes in the management of vascular trauma: institutional experience at a level 1 trauma center

Background: Vascular trauma remains a complex area for clinicians and its management is constantly evolving. The increasing use of endovascular modalities and non-operative management has led to significant changes in the treatment of vascular trauma. The aim of this study was to identify the current management and outcomes of vascular trauma at a Level 1 trauma centre in Queensland, Australia and compare this with the current literature.Methods: All individuals who presented to GCUH with vascular injuries between January 2014 and December 2019 were identified from the GCUH trauma database. A descriptive analysis was performed on this cohort.Results: 213 patients were identified in our cohort; 51 were managed non-operatively, 121 were managed with open surgery, 37 were managed endovascularly and 4 had a combination of open and endovascular intervention.Conclusions: The proportion of vascular injuries managed with endovascular interventions or non-operatively has increased within the study period. This study shows that the trends of management for vascular trauma in Australia are consistent with recent international literature.

SURGICAL MANAGEMENT OF TRAUMATIC ARTERIAL OF LIMBS IN ANTANANARIVO

Background: The prevalence of traumatic arterial of limbs in Antananarivo is unknown, and there is not a protocol for management of vascular trauma. The aim of this study was to describe epidemiology and surgical management of traumatic arterial of limbs in Antananarivo. &#x0D; Material and methods: This was a retrospective and descriptive study for a period of 10 years from January 2008 to December 2017 performed at the Cardiovascular Surgery Unit in JRA Teaching Hospital Antananarivo, including all patients who underwent a surgery for traumatic arterial injury of limbs. &#x0D; Results: Ninety-two cases of traumatic arterial of limbs has been recorded. The most victims were young (mean age=34.68), male (88.04%). The most mechanism of arterial injury was a civilian liability accident (63.04%) which 53.26% was due to stabs wounds. There were 82 cases of arterial wounds and 10 cases of blunt arterial trauma. Clinical signs were bleeding (89.12%), pulseless (46.73%) and hematoma (10.86%). Lesion were laceration (n=36), complete transection (n=32), avulsion (n=7), pseudoaneurysm (n=5), arteriovenous fistula (n=2), contusion (n=10). The most involved vessel were the brachial artery (29.34%) in the upper extremity and the femoral artery (15.21%) in lower extremity. Surgical procedure were revascularization (84.78%), ligation (9.78%) and primary amputation (5.43%). The overall limb salvage rate was 96.73% of arterial injuries successfully repaired. &#x0D; Conclusion: Revascularization is important in traumatic arterial injury of limbs. It must giving early to prevent an amputation of limbs.

Vascular Trauma in Civilian Practice- Experience at Lady Reading Hospital Peshawar Pakistan

Introduction - To evaluate vascular trauma management mainly on clinical assessment, at a less equipped set-up and compare the outcome in early and late presented patients. Methods - A prospective study of vascular trauma patients at Lady Reading, Peshawar. The nature, site, early and late presentation and outcome of surgery in vascular injuries presenting to our department between Jan 2007 to Dec. 2017 were assessed. Out of these cases, only few stable neck injuries had pre-operative angiographies. There were 2041 vascular injuries in 1952 patients (mean age 29, range 3—71 years). Mechanism and nature of injuries were assessed. Early presentations (group A: 667 cases < 8 hours) were compared with late presentations (group B: 1285 cases > 8 hours). The hospital mortality, complication, associated injuries and outcome were assessed. Results - Male accounted for 90% of patients. The majority of injuries (79.85%) were caused by bullets; followed by stab injuries (7.35%), blunt trauma (8.75%) and Iatrogenic (3.38%). 62.74% were arterial, 11.35% were venous, 24.10% were mixed, 2.11% had intact vessels. Upper limb injuries were 31.63%, lower limb (60.16%), remaining were neck or abdominal injuries. Associated injuries included fractures (16.38%), nerve injuries (25.42%), chest injuries (5.93%), abdominal (9.03%) and cervical spine or head injuries (1.41%). About 70% presented with hemorrhage and 80% with pulse deficit. Injuries treated with end-to-end anastomosis (44%), vein graft (21.46%), prosthetic graft (6.98%), lateral suture (16.66%), Ligation (5.36%), thrombectomy (4.51%) and primary amputation (2.25%), Group "A" had higher mortality than group "B" (16% vs. 5%) with amputation rate of (7.86% vs. 10.48%) and infection rate of (32% vs. 14.65%). Conclusion - The higher mortality in those arriving within 8 hours of injury reflects, their more severe injuries. Early recognition and prompt referral to vascular surgery center may save life and limbs in vascular trauma patients.