A perspective of extremity vascular trauma epidemiology and its management in a resource limited set up
Background: Extremity vascular injuries are one of the major causes of limb loss and potentially preventable deaths after trauma. Although it is a major challenge, especially in countries with a less established trauma center, early diagnosis, and intervention are important for a better outcome. The aim of this study was to describe the epidemiology, management strategies, and outcomes of extremity vascular trauma in the Ethiopian setting.
Methods: A retrospective observational study was conducted among all extremity vascular trauma patients who were admitted and treated at Tikur Anbessa Specialized Hospital (TASH) Between June 2015 and May 2020.
Result: A total of 85 patients with extremity vascular trauma, predominantly male (90.6%), were included in the study. The mean age was 27 ± 9 years. Penetrating trauma caused 89.4% of extremity vascular injuries. The majority of the injuries are caused by stab/sharp (40%), bullet (29.4%) and road traffic accidents (17.7%). The brachial artery was the commonest vessel injured accounting for 36.5% followed by femoral artery injury of (22.4%). The commonest types of vascular injuries were complete transection (74.1%), laceration (15.3%), and partial transection (8.2%). The most commonly used method of vascular reconstruction was reverse interposition venous graft accounting for 45.9%. Other methods were ligation & hemostasis (20%), primary repair with End-to-End Anastomosis (17.7%), primary simple repair (15.3%), and venous patch (1.2%). A limb salvage rate of 91.8% was achieved despite a 67.1% of late presentation (>6 hours).
Conclusion: Vascular injuries are mainly due to violence and road traffic accidents. Limb loss and mortality due to this injury can be mitigated by improving health policies, implementing emergency ambulatory systems, and provision of vascular services with better training centers.
Keywords: Trauma, vascular injury, epidemiology, vascular reconstruction, outcome