title: Management of upper extremity arterial injuries at an urban level I trauma center.
abstract: Although relatively uncommon, upper extremity arterial injuries are serious and may significantly impact the outcome of the trauma patient. Management of upper extremity arterial injuries at an urban level I trauma center was reviewed to determine incidence, assess the current management strategy, and evaluate hospital outcome. Upper extremity trauma patients with arterial injury who presented between January 2005 and December 2006 were included in this retrospective review. Data collected included age, gender, race, mechanism of injury, type of injury, associated upper extremity injuries, concomitant injuries, injury severity score (ISS), diagnostic modalities employed, surgical procedures and interventions, mortality, length of stay, and discharge disposition. Statistical analysis between blunt and penetrating arterial injuries as well as between proximal and distal arterial injuries also was conducted. During a 2-year period, 28 patients with 30 upper extremity arterial injuries were admitted, yielding an incidence of 0.48%. The study population was comprised primarily of young Caucasian males, with a mean ISS of 9.0. The majority (89.3%) of patients suffered concomitant upper extremity injuries. Twenty-two nerve injuries were identified in 16 (57.1%) patients. The most common injury mechanism was cut by glass (39.3%). Arterial injuries were categorized into 18 (60.0%) penetrating and 12 (40.0%) blunt injuries. Involved artery distribution was as follows: 12 (40.0%) brachial, eight (26.7%) ulnar, seven (23.3%) radial, and three (10.0%) axillary. Over half (56.7%) of the injuries resulted from lacerations. Injuries were managed as follows: 14 (46.7%) primary repairs, eight (26.7%) ligations, six (20.0%) saphenous vein graft bypasses, and two (6.7%) endovascular procedures. Eleven (39.3%) patients required intensive care unit (ICU) admission. The overall mean length of hospitalization for these patients was 7.4 days compared to a mean length of hospitalization of 2.0 days for the 17 (44.7%) patients who did not require ICU admission. The overall limb salvage rate was 96.4% as arterial injuries were successfully repaired in 27 of 28 patients. No patients expired and all were discharged home. Equivalent demographics, mechanisms of injury, surgical management approaches, and successful hospital outcomes were demonstrated between penetrating and blunt injuries as well as between proximal and distal arterial injuries. The current management approach, including use of angiography and prompt surgical management, results in successful outcomes after upper extremity arterial injuries and will continue to be utilized.
authors.affiliation: The Vascular and Vein Center at Grant Medical Center, Columbus, OH. rfranz2@ohiohealth.com
authors.forename: Randall W
authors.initials: RW
authors.lastname: Franz
authors.forename: Robert B
authors.initials: RB
authors.lastname: Goodwin
authors.forename: Jodi F
authors.initials: JF
authors.lastname: Hartman
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000293:injuries / Q000601:surgery; D003422:Critical Care; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008026:Ligation; D023821:Limb Salvage / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D019037:Urban Health Services / Q000706:statistics & numerical data; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult