Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston.
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston.
J Vasc Surg. 2024 Mar;79(3):526-531. doi: 10.1016/j.jvs.2023.11.028. Epub 2023 Nov 20.
Civilian analyses of long-term outcomes of upper extremity vascular trauma (UEVT) are limited. Our goal was to evaluate the management of UEVT in the civilian trauma population and explore the long-term functional consequences.
A retrospective review and analysis was performed of patients with UEVT at an urban Level 1 trauma center (2001-2022). Management and long-term functional outcomes were analyzed.
There were 150 patients with UEVT. Mean age was 34 years, and 85% were male. There were 42% Black and 27% White patients. Mechanism was penetrating in 79%, blunt in 20%, and multifactorial in 1%. Within penetrating trauma, mechanism was from firearms in 30% of cases. Of blunt injuries, 27% were secondary to falls, 13% motorcycle collisions, 13% motor vehicle collisions, and 3% crush injuries. Injuries were isolated arterial in 62%, isolated venous in 13%, and combined in 25% of cases. Isolated arterial injuries included brachial (34%), radial (27%), ulnar (27%), axillary (8%), and subclavian (4%). The majority of arterial injuries (92%) underwent open repair with autologous vein bypass (34%), followed by primary repair (32%), vein patch (6.6%), and prosthetic graft (3.3%). There were 23% that underwent fasciotomies, 68% of which were prophylactic. Two patients were managed with endovascular interventions; one underwent covered stent placement and the other embolization. Perioperative reintervention occurred in 12% of patients. Concomitant injuries included nerves (35%), bones (17%), and ligaments (16%). Intensive care unit admission was required in 45%, with mean intensive care unit length of stay 1.6 days. Mean hospital length of stay was 6.7 days. Major amputation and in-hospital mortality rates were 1.3% and 4.6% respectively. The majority (72%) had >6-month follow-up, with a median follow-up period of 197 days. Trauma readmissions occurred in 19%. Many patients experienced chronic pain (56%), as well as motor (54%) and sensory (61%) deficits. Additionally, 41% had difficulty with activities of daily living. Of previously employed patients (57%), 39% experienced a >6-month delay in returning to work. Most patients (82%) were discharged with opioids; of these, 16% were using opioids at 6 months.
UEVT is associated with long-term functional impairments and opioid use. It is imperative to counsel patients prior to discharge and ensure appropriate follow-up and therapy.
关于上肢血管外伤（UEVT）的长期结局，民用分析十分有限。我们的目标是评估民用创伤患者的 UEVT 管理情况，并探讨其长期功能后果。
对城市一级创伤中心（2001-2022 年）的 UEVT 患者进行回顾性分析和研究。分析了患者的治疗和长期功能结果。
共纳入 150 例 UEVT 患者，平均年龄 34 岁，85%为男性，42%为黑人，27%为白人。创伤机制为穿透伤 79%，钝性伤 20%，多因素伤 1%。穿透伤机制中，30%为枪支伤。钝性伤中，27%为坠落伤，13%为摩托车事故伤，13%为机动车事故伤，3%为挤压伤。单纯动脉伤 62%，单纯静脉伤 13%，联合伤 25%。单纯动脉伤包括肱动脉（34%）、桡动脉（27%）、尺动脉（27%）、腋动脉（8%）和锁骨下动脉（4%）。92%的动脉损伤行开放性修复，自体静脉旁路移植（34%），其次是一期修复（32%）、静脉补片（6.6%）和人工移植物（3.3%）。23%的患者行筋膜切开术，其中 68%为预防性切开。2 例患者接受了血管内介入治疗，1 例采用了带膜支架植入，另 1 例采用了栓塞。术后 12%的患者需要再次干预。同时合并神经损伤（35%）、骨损伤（17%）和韧带损伤（16%）。45%的患者需要入住重症监护病房，平均入住重症监护病房 1.6 天。平均住院时间为 6.7 天。主要截肢和院内死亡率分别为 1.3%和 4.6%。72%的患者有超过 6 个月的随访，中位随访时间为 197 天。19%的患者出现创伤后再入院。许多患者有慢性疼痛（56%）、运动（54%）和感觉（61%）障碍。此外，41%的患者日常生活活动困难。在有工作的患者中（57%），39%的患者重返工作岗位的时间延迟了 6 个月以上。大多数患者（82%）出院时使用阿片类药物，其中 16%在 6 个月时仍在使用阿片类药物。
UEVT 与长期功能障碍和阿片类药物的使用有关。在患者出院前必须进行咨询，并确保适当的随访和治疗。
