Repair of arterial injury after blunt trauma in the upper extremity - immediate and long-term outcome.
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.
Klocker
J
J
Department of Vascular Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. josef.klocker@i-med.ac.at
Falkensammer
J
J
Pellegrini
L
L
Biebl
M
M
Tauscher
T
T
Fraedrich
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000098:blood supply*; D001134:Arm Injuries / Q000401:mortality / Q000601:surgery*; D001158:Arteries / Q000293:injuries* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*