‘Excellent’ limb salvage rates for trauma bypass performed by vascular surgeons

Clement Darling, MD

Revascularization for extremity trauma can be performed with excellent limb salvage rates, though poor compliance with long-term surveillance raises some cause for concern.

These are among the primary messages presented from a study detailing the experience and outcomes of a rural, level one, trauma center performing upper- or lower-extremity revascularization in trauma patients over a 20-year timespan, in which investigators sought to identify bypass failure modes and surveillance protocols.

Vascular surgery resident Misak Harutyunyan, MD, presented the analysis during this morning’s Plenary Session 7 (8:00–9:30 a.m.) in Potomac A/B, on behalf of the Albany Medical College vascular team, including senior author Jeffrey Hnath, MD, and submitting author R. Clement Darling, MD. The Albany team posits that long-term outcomes in civilian trauma patients requiring upper- or lower-extremity revascularization has been poorly studied, secondary to limitations of certain large databases and the nature of the patients in this specific vascular subset.

Their dataset offers up insights from 223 revascularizations performed between January 2002 and June 2022. Of these patients 161 (72%) had lower and 62 (28%) upper extremities. The Albany team reports an operative mortality rate of 4.5% (n=10), all involving lower-extremity revascularization. Thirty-day non-fatal complications included immediate bypass occlusion in 11 patients (4.9%), wound infection in 7 (3.1%), graft infection in 6 (2.7%), and lymphocele/seroma in 5 patients (2.2%). All major amputations (13, 5.8%) were early and in the lower extremity bypass group, the study’s authors report. Late revisions in the lower- and upper-extremity groups were 14 (8.7%) and 2 (3.2%) respectively.

Although the study’s authors are set to report that revascularization for extremity trauma can be performed with excellent limb salvage rates, demonstrating long-term durability with low limb loss and bypass revision rates, they also sound a note of caution over poor compliance with long-term surveillance. “The poor compliance with long-term surveillance is concerning and may require adjustment in patient retention protocols,” they will state, adding, however, that “emergent returns for bypass failure are extremely low in our experience.”


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