Repair of Arterial Injury after Blunt Trauma in the Upper Extremity – Immediate and Long-term Outcome

Abstract Objective In contrast to upper extremity stab and gunshot wounds, data on management and outcome in blunt trauma (BT) are limited by small numbers and short follow-up periods. Methods This study is a retrospective data analysis. All patients who had undergone arterial repair after upper-limb BT were included. Exclusion criteria were artery ligation and/or primary limb amputation. Endpoints included the following: peri-operative death, limb salvage, primary and secondary patency, vascular re-operation and/or intervention. Results Eighty-nine patients (71 male; median age: 34.6 years, range: 2.5–81.7) underwent reconstruction of 96 arteries after BT since 1989: subclavian ( n = 16), axillary ( n = 22), brachial ( n = 48) and forearm ( n = 10). Concomitant arm vein lesions were present in 15 patients (17%) and accompanying nerve ( n = 38; 43%) and/or orthopaedic injuries ( n = 64; 72%) in 77 patients (87%). The 30-day mortality rate was 2% with the limb-salvage rate being 98%. Six reconstructions occluded during the first week (primary/secondary patency rate: 93%/99%). After a median follow-up time of 5.1 years, 67% of the patients were followed: There were no secondary amputations and no arterial re-interventions. Conclusions Arterial repair in upper extremity BT has excellent early and long-term outcome. In contrast to a significant risk of early occlusion, limb loss after repair, late vascular re-intervention and late arterial occlusion or stenosis are rare.