Taking the long view in traumatic peripheral vascular injury repair: An analysis of the PROspective Observational Vascular Injury Treatment postdischarge follow-up registry

INTRODUCTION: Outcomes following peripheral arterial repair (PAR) in trauma are generally limited to inpatient or 30-day complications. This study aims to characterize long-term outcomes using extended postdischarge follow-up data after PAR. METHODS: The postdischarge follow-up module of the PROspective Observational Vascular Injury Treatment registry (2012-2023) was used to identify patients with PAR who survived to discharge. Rates of in-hospital and postdischarge vascular complications (VCs), as well as postdischarge visit frequency and timing, evaluation methods, and antithrombotic therapy, were collected. Baseline and injury characteristics as well as management factors associated with either in-hospital or postdischarge VC were evaluated. Outcomes were also compared between repair techniques. RESULTS: A total of 1,158 PAR cases surviving to discharge were identified, with 523 (45.2%) having postdischarge follow-up data. Peripheral arterial repair included 46.3% primary repairs, 48.4% autologous vein repairs, and 5.3% prosthetic repairs. During hospitalization, 14.3% of patients experienced VCs. Postdischarge VCs were identified in 8.4% of patients with postdischarge follow-up within a median follow-up time of 2 months (range, 1-70 months). Postdischarge VCs included 12 reinterventions (2.3%), 6 cases of infection (1.1%), 4 instances of ischemia (0.8%), 3 technical issues with repairs (0.6%), 3 cases of stenosis (0.6%), 2 thromboses (0.4%), 2 occlusions (0.4%), 2 amputations (0.4%), and 1 pseudoaneurysm (0.2%). No repairs were complicated by bleeding, hematoma, stroke, or spontaneous rupture. The highest rates of in-hospital and postdischarge VC were seen after prosthetic repair, compared with autologous vein and primary repairs. CONCLUSION: There is a substantial incidence of PAR-related VC after trauma, with a postdischarge incidence approximately half that of the in-hospital incidence. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.