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Ten-year Review of Penetrating Upper Extremity Vascular Injury at a Level 1 Trauma Center
Nadj L. Pierre, MD.
WellSpan York Hospital, York, PA, USA

Objective: Evaluate trends and outcomes to penetrating vascular upper extremity injury.  Methods: We reviewed the penetrating upper extremity vascular traumas that presented to our Level-1 trauma center from 2013 to 2022. We performed a retrospective study to analyze the most common injuries, their mechanisms, and the associated outcomes. Brachial artery injuries were diagnosed by physical examination, doppler ultrasonography, and CT arteriography. The mechanism of injury, method of repair, associated injuries, and outcomes were evaluated. Results: 115 patients were identified. 95 (83.3%) of the patients were males and 19 (16.7%) were female. The average age was 37.69 (Median 34, Min 18, Max 86). The average Injury Severity Score (ISS) was 5.74 with a median of 5. The average ICU length of stay was 0.35 with a median of 0 (Min 0, Max 14). The average LOS was 2.29, with a median of 1. There were two mortalities of the sample. For those mortalities, the patientsí ISS were 50 with other injuries including GSW to the Right ventricle and 14 with injuries of Anoxic brain injury and abdominal compartment syndrome). The mechanisms of injury included stabbing (92, 80.7%), gunshot wounds (13, 11.4%), fall (3, 2.64%) and industrial accidents (4, 3.51%). Vascular injuries were to the radial artery (24.56%), Ulnar artery (10.53%, Radial digial (7.02), Ulnar Digital (3.51%), and Brachial (1.75%). The repair of arterial injuries included ligation in 14, interposition vein graft in 4 cases, and primary repair in 17 cases. 6 patients (5.26%) underwent digital amputations. The result of the Pearson correlation showed that there was a significant correlation between ISS and LOS, r(112) = 0.33, p = <.001. The result of the Pearson correlation showed that there was a significant correlation between ISS and ICU LOS, r(112) = 0.42, p = <.001. Conclusion: Although studies have reported brachial artery as most commonly injured in trauma, this single institution found the radial artery to be most commonly affected. This single level 1 trauma center retrospective study showed there was a positive correlation between ISS and LOS in Upper extremity Penetrating Vascular Trauma Patients. Arteries were most commonly ligation. No patients underwent a major amputation but 5 did undergo digital amputations.


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