Abstract
Objective: The frequency, operative management, and outcomes for patients with traumatic vascular injury in the UK are unknown. The Vascular Interventions and Surgery in Trauma Audit (VISTA) aimed to describe the contemporary landscape of UK vascular trauma compared with retrospective data from the National Vascular Registry (NVR).
Methods: A prospective, resident led service evaluation was conducted across UK major trauma centres (MTCs) delivered by the National Trauma and Research Innovation Collaborative and the Vascular and Endovascular Research Network. The evaluation included patients with traumatic injuries to named vessels falling under the management remit of vascular surgery, identified radiologically or intra-operatively, between March and October 2022 and comparative NVR data from 2017 to 2022.
Results: VISTA captured 302 patients with 339 vascular injuries from 27 MTCs. The median patient age was 41 years (interquartile range 26, 59) and 78.8% (n = 238) were men. Most injuries resulted from road traffic collisions (42.4%, n = 128). Overall, 38 patients (12.6%) were shocked on arrival at the emergency department. Two thirds of patients (65.6%, n = 198) required surgery, of whom 140 (70.7%) had an open procedure and 58 (29.3%) an endovascular intervention. Open procedures included 86 (61.4%) extremity interventions (including six [4.3%] primary amputations), four (2.9%) carotid repairs, four (2.9%) caval repairs, and two (1.5%) aortic repairs. Endovascular procedures included 23 (40%) thoracic endovascular aortic repairs, two (3%) extremity stents, and one (2%) extremity embolisation. The secondary amputation rate was 12% (10 of 86). Extrapolated annual VISTA data suggest the NVR fails to capture 58% of aortic injuries and 42% of extremity vascular injuries requiring intervention.
Conclusion: UK wide registries do not accurately capture surgical volume and outcomes for vascular interventions following trauma. Granular national datasets are required to establish evidence based key performance indicators for life and limb salvage following vascular trauma to improve services, promote safety, and assure patient outcomes.