Operative treatment and clinical outcomes in peripheral vascular trauma. The combined experience of two centres in the endovascular era.

Arterial traumas of the extremities are quite rare in civilian records; nevertheless, patients with trauma of limbs are admitted daily in emergency departments worldwide. The up-to-date information about epidemiology and treatment (open vs endovascular surgery) comes from war records and it is not always easy getting data on mortality and morbidity in these patients. The aim of this study is to analyse the approach (open or endovascular) and the outcome of patients with vascular trauma of upper limbs (from the subclavian artery) and/or lower limbs (distal to the inguinal ligament), in the greater Milan area.A retrospective analysis was conducted on data recorded by the emergency departments of two hospitals of the greater Milan between 2009-2017. We collected all patients with arterial injuries of the limbs in terms of demography, injury patterns, clinical status at admission, therapy (open or endovascular approach) and outcomes in terms of limb salvage and survival.We studied 52 patients with vascular trauma of extremities. The main mechanism of trauma was road accident (48.1%), followed by criminal acts (32.7%), self-endangering behaviour (13.5%), work (3.8%) and sport accidents (1.9%). Associated lesions (orthopaedic, neurological and/or venous lesions of the limbs) were present in 39 patients (75%). All patients underwent emergency surgery, forty six patients (88,5%) by open repair (PTFE or greater saphenous vein bypass grafts, arterial suture or ligation) while endovascular approach was used only in 6 patients (11.5%), all treated with embolization. The overall post-operative mortality rate was 5.7% (3 patients). Among survivors, we report 5 major amputations of the lower limbs, 3 of them after bypass graft infection and 2 after graft failure. The rate of limbs salvage was 90.4%.Isolated arterial trauma of the extremities are rare, usually they occur in the setting of multiple trauma patients. Despite progresses in surgical techniques, there are still controversies in diagnosis and treatment of these patients. We treated the majority of cases with open surgery (n=46), choosing endovascular approach (embolization performed mainly by interventional radiologists) in difficult anatomic districts. We believe that, during decision making of the surgical strategy, it is important to consider the anatomical site of lesions and the general condition of the patients. Moreover, in case of multiple trauma, we suggest a multidisciplinary approach in order to provide the best medical care to the victims.