Peripheral vascular trauma in a civilian Asian trauma centre: Epidemiology, management and outcomes over 9 years

Background Peripheral vascular injuries (PVI) are uncommon but potentially limb-threatening complications of extremity trauma. Most existing literature originates from military settings or Western trauma systems. We aimed to describe the epidemiology, management strategies, and outcomes of traumatic PVI in a civilian tertiary trauma centre in Singapore. Methods A retrospective cohort study was conducted using the institutional trauma registry of Tan Tock Seng Hospital between January 2013 and December 2021. Patients presenting with upper or lower extremity vascular injuries were identified using Abbreviated Injury Scale (AIS) coding. Demographics, injury characteristics, anatomical injury patterns, interventions, and outcomes including limb salvage, complications, and inpatient mortality were analysed. Comparisons between upper and lower limb injuries were performed using appropriate statistical tests. Results Among 77,990 trauma admissions, 180 patients sustained PVI (incidence 0.23%). Median age was 36 years and 87% were male. Overall, penetrating trauma was more common (58.9%), but lower limb injuries were predominantly due to blunt trauma (68%), particularly road traffic accidents. Lower limb PVIs were associated with higher injury severity than upper limb PVIs (p<0.001). Operative management was required in most arterial and venous injuries. Primary repair and endovascular interventions demonstrated excellent limb salvage, whereas bypass procedures were associated with lower salvage rates. Overall limb salvage for lower limb PVI was 88%, with an amputation rate of 10% and mortality of 3%. Most (93%) were functionally independent at discharge. Conclusions PVI predominantly affects young male patients and are commonly associated with blunt trauma from road traffic accidents. Despite significant injury severity, favourable limb salvage and functional outcomes can be achieved with timely multidisciplinary management. These findings highlight the importance of coordinated multidisciplinary trauma care in optimizing outcomes following extremity vascular trauma.