Arterial trauma of the limbs and pelvis: A 6-year experience of an urban trauma centre

Aim-Background Vascular trauma is followed by high morbidity, with iatrogenic injuries showing an increase in incidence during the last decade. The aim of this study is to present the 6-year experience of an urban trauma centre concerning the management of vascular trauma. Methods All major arterial injuries of the extremities treated during a 6-year period (08/2008- 08/2014) were retrospectively studied. Arterial injuries of the thorax/abdomen and major venous injuries were not included. All cases were classified into iatrogenic and non-iatrogenic injuries. Results Overall, 15 (22%) iatrogenic and 52 (78%) non-iatrogenic injuries were managed. Patients with iatrogenic injuries were older (P = 0.001) and mainly female (P = 0.0002) compared to those with non-iatrogenic injuries. Orthopedic surgery was responsible for the majority of iatrogenic cases, and motor vehicle accidents accounted for most of the non-iatrogenic cases. Popliteal (36%) and brachial (27%) arteries were the most commonly injured vessels. Almost 10% of patients needed primary/secondary amputation, with injury of a major nerve, bone fracture and extensive soft tissue loss being the major risk factors. Endovascular treatment was selected for the majority of iatrogenic injuries, although open repair was the primary management for non-iatrogenic cases. All grafts remain patent after a mean follow-up of 3.6 years. Conclusions Iatrogenic and non-iatrogenic arterial injuries of the extremities show different characteristics concerning epidemiology and management, which should be taken into consideration by the treating physician. Injury of major adjacent structures remains a major risk factor for amputation.