LAUSR

INTRODUCTION Brachial artery injuries are rare even in busy urban Trauma Centers. They account for approximately 25-33% of all peripheral vascular injuries. They are the second most common extremity vessel injury in military and urban civilian arenas of warfare. The objectives of this study are to report our experiences with brachial artery injuries, identify predictors of outcome, and correlate length of ischemic time with mortality and limb outcomes. We hypothesized that maintaining ischemic times to six hours would result in improved outcomes with increased limb salvage and decreased amputation rates. METHODS Retrospective 118-month study of all patients admitted with a confirmed brachial artery injury. SETTING Large Urban Level 1 Trauma Center. MAIN OUTCOME MEASURES Total operative time from admission to restoration of blood flow/tissue perfusion, surgical interventions, outcomes, including survival and limb salvage/amputation rates. STATISTICAL ANALYSIS univariate and multivariate stepwise logistic regression. RESULTS There were 124 patients with 131 brachial artery injuries. Mean RTS - 7.32 ± 1.4; Mean ISS - 11.3 ± 8.8; Mechanism of Injury (MOI) including: penetrating - 108 (87%) patients; and blunt- 16 (13%) patients. OPERATIVE MANAGEMENT INCLUDED Reverse saphenous vein (RSVG) interposition grafts - 77 (62%), primary end-to-end anastomosis - 37 (29.8%), ligation - 4 (3.2%), vein patches - 2 (1.2%). No patients required temporary shunts or underwent Stenting. Fasciotomies - 23 (19.2%) patients. OUTCOMES 120 patients survived, Overall survival rate - 96.8%. Adjusted survival rate excluding intraoperative deaths - 100%. Overall limb salvage/amputation rate - 95.1%/4.9%. Adjusted limb salvage/amputation rates excluding intraoperative deaths - 98.3%/1.67%. UNIVARIATE ANALYSIS Mean Ischemic times for survivors was 5 ± 3.1 hours (300 ± 186 minutes) versus ischemic times for non survivors - 3 ± 2.2 hours (180 ± 132 minutes) (p=0.017). Other selected patient characteristics included GCS (p<0.001), ISS (p=0.002), EBL (p=0.024), number of platelet units transfused (p=0.003), and Hospital LOS (p=0.044). Separate Logistic Regression Analysis identified the following independent predictors of outcome for survival: MOI: Penetrating [p=0.015, RR - 4.29, 95% CI: 1.49-12.36], GCS, < 7 [p<0.001, RR - 21.71, 95% CI: 9.37-50.32], ISS > 15 [p<0.005, RR - 4.98, 95% CI: 1.68 - 14.73], Patients not requiring ED Thoracotomy [p=0.009, RR - 7.48, 95% CI: 2.58-21.69], Arterial injury location left versus right [p=0.002, RR - 11.4, 95% CI: 1.47 - 84.23], and traumatic amputation [p=0.004, RR - 6.95, 95% CI: 2.48-19.53]. CONCLUSIONS Brachial artery injuries are rare and pose challenges to Trauma and Vascular Surgeons. Patients not requiring ED Thoracotomy, GCS, ISS, and EBL predicted survival. Out adjusted limb Salvage rate - 98.3%. Patients succumbing with brachial artery injuries die from associated injuries and thus experience less ischemic times than survivors who are able to undergo repairs.