The delayed management of main arterial injuries in extremity trauma: Surgical challenges and outcomes

Objective: To analyse the early outcome of main arterial injuries with delayed treatment in extremity trauma and help vascular surgeons in determining proper treatment strategy for such injuries. Methodology: Forty-three patients with delayed treatment of main arterial injuries during May 2003 and January 2008 were reviewed retrospectively. Results: In 43 patients, injuries were caused by blunt trauma in 26 cases and penetrating trauma in 17 cases. The maximum ischaemia time was 38 hours and the minimum was 13 hours. Eight patients underwent primary amputations and four patients underwent secondary amputation. There was no perioperative mortality, while wound infection occurred in five patients, followed by graft occlusion in four patients, arteriovenous fistulae in two patients and pseudoaneurysm in one patient. Conclusion: The delayed intervention in main arterial injuries is associated with higher risk of amputation, while the suitable surgical techniques may decrease the risk of limb loss. Viable limbs should be revascularized in otherwise stable patients even with long periods of ischaemia.