Outcomes of Traumatic Arterial Injuries in Upper vs. Lower Extremities

Study Overview
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Brief Summary
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The purpose of this study is to identify and compare the causes of vascular trauma at the extremities, injury characteristics, types of vascular surgical interventions, and the outcomes of traumatic vascular injuries between the upper and lower extremities.

Detailed Description
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Primary patient assessment Patients will be clinically assessed on presentation, and resuscitation protocols will be initiated if signs of hypovolemic shock are present according to Advanced Trauma Life Support guidelines. History and physical examination are the most important components of the diagnostic protocol The presence of hard signs of arterial injury Absent or diminished pulses Active haemorrhage Large, expanding, or pulsatile hematoma Bruit or thrill Distal ischemia is considered an indication for surgery, and no further specific investigative measures will be taken. Soft signs of vascular trauma should be noted as well including Small, stable hematoma Unexplained hypotension History of haemorrhage that is no longer present Proximity of injury to major vessels Investigations including: The use of a hand-held Doppler examination as a diagnostic aid Duplex US and CTA for imaging. Lab investigations: Complete blood picture, Coagulation profile and Kidney function tests. Options of intervention: All vascular trauma patients will be admitted for operative management and follow up. The specific surgical intervention will be determined by the vascular surgeon according to type, site, and extent of the injury, ranging from ligation of the injured vessel to vascular graft interposition. An injury to a peripheral artery that does not result in complete transection can be repaired depending on luminal diameter with an interrupted or continuous suturing technique. A complete transection of a peripheral artery is first managed with minimal debridement back to healthy intima at both ends then an end-to-end anastomosis or with an interposition graft of autogenous vein or prosthetics arterial graft.

Official Title
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Outcomes of Traumatic Arterial Injuries in Upper vs. Lower Extremities

Conditions
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Vascular Trauma

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All peripheral arterial injuries of one or more of the extremities. Exclusion Criteria: Vascular injuries limited to the venous system only. Vascular injuries limited to thoracic, abdominal, or neck vessels.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Upper extremity arterial trauma<br>Vascular traumatic injuries of the arterial system of the upper limbs. | |
| Lower extremity arterial trauma<br>Vascular traumatic injuries of the arterial system of the lower limbs. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Presence of distal pulse or signals by doppler ultrasound | Presence of distal pulse or signals by doppler ultrasound which indicates technical success of the surgery and patency of the affected artery | Intraoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Type of the injury in the upper extremities compared with the lower extremities | blunt or penetrating injury by history and clinical examination | Preoperative | 
| Presentation of the injury in the upper extremities compared with the lower extremities | Bleeding or ischemia by clinical examination. | Preoperative | 
| Presence of injury related complications in the upper extremities compared with the lower extremities | Presence of complications(or not) like compartment syndrome, hematoma or/and associated nerve deficit by clinical examination. | Preoperative | 
| Presence of postoperative complications in the upper extremities compared with the lower extremities | Presence of complications(or not) like thrombosis of the repaired vessel, pseudoaneurysm formation or/and deep vein thrombosis by clinical examination and Duplex ultrasound evaluation. Presence of complications(or not) like surgical site infection or/and wound dehiscence by clinical examination and culture and sensitivity. | Postoperative for 10 days |