Trauma bypass performed by vascular surgeons demonstrate excellent long-term outcomes and limb preservation

Long-term outcomes in civilian trauma patients requiring upper or lower extremity revascularization are poorly studied secondary to limitations of certain large databases and the nature of the patients in this specific vascular subset. This study reports on the experience and outcomes of a rural level one trauma center that provides virtually all follow-up care over a 20-year period to identify bypass failure modes and bypass surveillance protocols. Database of a single vascular group at an academic center was queried for trauma patients requiring upper or lower extremity revascularization between January 1, 2002, and June 30, 2022. Patient demographics, indications, operative details, operative mortality, 30-day nonoperative morbidity, revisions, subsequent major amputations, and follow-up data were analyzed. There were 223 revascularizations were performed—161 (72%) lower and 62 (28%) upper extremities. Of these patients. 167 (74.9%) were male with a mean age of 39 years (range, 3-89 years). Comorbidities included 34 (15.3%) with hypertension, 6 (2.7%) with diabetes, and 40 (17.9%) with tobacco use. Mean follow-up time was 23 months (range, 1-234 months), with 90 (40.4%) patients lost to follow-up. The mechanism of injury was blunt trauma in 106 (47.5%), penetrating trauma in 83 (37.2%), and operative trauma in 34 (15.3%). Bypass conduit was reversed vein in 170 (76.2%), prosthetic in 34 (15.3%), and orthograde vein in 14 (6.3%). Bypass inflow artery was the superficial femoral in 65 (40.4%), above-knee popliteal in 27 (16.8%), and common femoral in 22 (13.7%) in the lower extremity and brachial in 40 (64.5%), axillary in 10 (16.1%), and radial in 6 (9.7%) in the upper extremity. Lower extremity outflow artery was the posterior tibial in 47 (29.2%), below-knee popliteal in 41 (25.5%), superficial femoral in 15 (9.3%), dorsalis pedis in 11 (6.8%), common femoral in 10 (6.2%), and above-knee in popliteal 10 (6.2%). Upper extremity outflow artery was the brachial in 34 (54.8%), radial in 13 (20.9%), and ulnar in 13 (20.9%). Operative mortality was 10 (4.5%), all involving lower extremity revascularization. The 30-day nonfatal complications included immediate bypass occlusion in 11 (4.9%), wound infection in 7 (3.1%), graft infection in 6 (2.7%), and lymphocele/seroma in 5 (2.2%). All major amputations (13; 5.8%) were early and in the lower extremity bypass group. Late revisions in the lower and upper extremity groups were 14 (8.7%) and 2 (3.2%), respectively. Revascularization for extremity trauma can be performed with excellent limb salvage rates and have demonstrated long term durability with low limb loss and bypass revision rates. The poor compliance with long-term surveillance is concerning and may require adjustment in patient retention protocols, however emergent returns for bypass failure are extremely low in our experience.