Trends in the Management of Peripheral Arterial Injuries: A Five-Year National Analysis

Introduction: Peripheral vascular injuries are rare with high rates of morbidity and long-term sequelae. The aim of this study is to study the trends in vascular injuries and management across American College of Surgeons–verified Level I trauma centers. Methods: We performed a 5-y retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database for the years 2017-2021. We included all patients with peripheral arterial injuries (axillary, brachial, radial, ulnar, femoral, popliteal, and tibial arteries) that underwent open or endovascular repair. Trauma centers were stratified into tertiles based on the volume of these vascular injuries into low volume (LV), medium volume (MV), and high volume (HV) centers. The primary outcome was rates of open and endovascular repair. The secondary outcome was amputation. Descriptive statistics and trend analysis were performed. Results: We identified a total of 22,057 patients with peripheral arterial injuries managed at 340 trauma centers (243 LV; 73 MV; 24 HV). Overall, the mean age was 36 (16) y; 83% were male. Nearly 30% sustained blunt injuries with a median injury severity score of 9 [3-13]. HV centers deal with an average of 27 cases/y. The rates of open and endovascular repairs were 63% and 13%, respectively. HV centers were more likely to perform endovascular repair (LV 11% versus MV 12% versus HV 14%, P < 0.001). There was no clinically significant difference between the HV, MV, and LV centers in terms of amputations (HV: 2.9% versus MV: 3% versus LV: 2.5%). On linear regression analysis, the proportion of endovascular procedures has linearly increased from 12% in 2017 to 14% in 2021 (β = 0.013, 95% confidence interval = 0.010-0.016, P < 0.001). Conclusions: Peripheral arterial injuries remain a complex clinical challenge. Nearly one-third of the peripheral arterial injuries are due to blunt mechanisms. Open repair remains the most preferred method of management. However, the outcomes remain equivocal irrespective of volume. Current training programs need to identify ways to improve training in open repairs for vascular injuries.