Clinical outcome of extremity arterial injuries in the modern era

TL;DR

This study examines the outcomes of patients with arterial injuries in the limbs, identifying risk factors and treatment approaches that affect recovery, amputation, and mortality rates.

Contribution

The study provides updated insights into clinical predictors and treatment strategies for extremity arterial injuries in a modern trauma setting.

Findings

Hypotension, pulselessness, and hypoesthesia were significant predictors of adverse outcomes.

Primary repair was the most common treatment modality for extremity arterial injuries.

Lower extremity injuries had higher amputation and mortality rates compared to upper extremity injuries.

Abstract

Extremity arterial injuries (EAIs) present a significant clinical challenge due to the risk of limb ischemia, amputation, and mortality. This retrospective cohort study aimed to delineate the clinical course, treatment strategies, and patient outcomes following trauma-induced EAIs, and to identify independent predictors of adverse outcomes.

Retrospectively analyzed were data from 168 consecutive patients with traumatic EAIs who underwent computed tomography angiography at a tertiary care center between 2019 and 2025. Data extracted from electronic medical records included demographics, injury mechanisms, clinical presentation, laboratory findings, imaging results, treatment modalities (primary repair, grafting, endovascular intervention, conservative management), and patient outcomes (sequelae-free recovery, amputation, mortality).

The primary outcome was sequelae-free recovery, while secondary outcomes included amputation, and mortality. The entire patient follow-up period, encompassing all treatment modifications, extended from emergency department admission until the primary or secondary outcome was reached. This period included hospitalization, postdischarge care (if applicable), and all subsequent outpatient clinic visits. Mortality was attributed only when directly causal.

The mean age of the patients was 37 ± 15 years, with a male predominance (86%). Penetrating trauma was the primary etiology for upper extremity injuries, while blunt trauma predominated in lower extremity injuries. Clinical presentation varied, with pulsatile bleeding significantly associated with penetrating trauma and hypoesthesia with blunt trauma. Independent predictors of adverse outcomes included hypotension, pulselessness, hypoesthesia, and elevated international normalized ratio (≥1.2). Base deficit was significantly associated with adverse outcomes in upper EAIs. Treatment modalities included primary repair (51.2%), grafting (10.1%), endovascular intervention (8.2%), and conservative management (28%). Amputation rates were 1.3% for upper extremities and 5.3% for lower ones, while mortality rates were 2.6% and 3.3%, respectively.

Early diagnosis, prompt surgical intervention, and a multidisciplinary approach are essential for optimizing patient outcomes. Hypotension, pulselessness, and hypoesthesia were identified as significant independent predictors of adverse outcomes. Future multicenter studies are warranted to validate these findings.

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