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The purpose of this study was to examine demographic and baseline characteristics of patients with vascular injuriesof extremities and to define the most relevant factors which influenced an early outcome, as well as limb salvage after the management of vascular trauma.This study used the database that included 395 patients with peripheral arterial injuries, who were treated in the tertiary vascular university center in the period between 2005-2020. Exclusion criteria were isolated thoracic, abdominal and neck injuries as well as iatrogenic injuries and injuries of intravenous addicts. Univariate binary logistic regression analysis and multiple logistic regression were used to determine risk factors for lomb loss (after vascular reconstruction) or mortality. Decision to perform primary amputation (without vascular reconstruction) was based on surgeons' preference and experience.Out of 395 vascular injuries treated in the period 2005-2020, 210 (53.2%) presented with non-iatrogenic vascular injuries of upper and lower extremities were analyzed. According to the univariate regression analysis, hemorrhage as the main clinical manifestation on admission (p=0.035) and early reintervention (p=0.048) increased, while an early patency of repaired artery (0.010) significantly decreased a 30-day amputation rate. Multivariate logistic regression analysis of these three variables showed that only early patency of repaired artery significantly decreased the early amputation rate (p=0.009).Based on presented experience, the patency of vascular reconstruction plays a crucial role in limb salvage in patients with non-iatrogenic peripheral vascular injuries. All factors that might influence the patency should be in focus of improvement.

The purpose of this study was to assess the clinical presentation and contemporary management of arterial thoracic outlet syndrome (TOS) in high-volume referral center.We conducted a retrospective review of a prospectively maintained database of patients with TOS of any etiology between January 1Sixty-three consecutive patients underwent surgical treatment due to arterial TOS. Period 2 had more patients who were asymptomatic (N.=16, 44.4% vs. N.=0, 0%, P0.001) and those presenting with critical hand ischemia (N.=12, 33.3% vs. N.=0, 0%, P=0.01), while acute limb ischemia was more common in period 1 (N.=16, 59.2% vs. N.=5, 13.9%, P0.001). SA compression without lesion was more common in period 2 (N.=16, 44.4% vs. N.=0, 0%, P0.001), while SA intimal damage with mural thrombus formation was more common in the period 1 (N.=12, 44.4% vs. N.=1, 2.7%, P0.001). Decompression as an isolated procedure was performed in 25.4% (N.=16) of all asymptomatic patients, while combined decompressive and vascular procedure in 71.4% (N.=45) of patients. The most common postoperative complication was pneumothorax (N.=7, 11.1%).The supraclavicular approach with its modifications provides adequate decompression and allows also repair or reconstruction of the SA, as well as complete additional revascularization of the upper extremity without the need for further patient repositioning. While treatment methods and early outcomes have not changed significantly over time, there has been a trend towards different clinical and SA pathomorphological presentation.

At the beginning of the second decade of the 20th century, Serbian surgeon V. Soubbotitch reported his experience with the treatment of vascular injuries from Balkan Wars (1912-1913). And, at the end of the 20th century, the former Yugoslavia experienced civil war; and thanks to this unpleasant fact, the author's generation of vascular surgeons had an oportunity to treat a significant number of war vascular injuries. In the absence of national registers, the most reliable data about vascular injury in Serbia can be found in the database of the Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre. That database collected 590 peripheral arterial injuries (140 war, 273 civil, and 142 iatrogenic vascular injuries). Those data showed that the treatment of vascular injury in the region of the Western Balkans is associated with two main problems. The first one is inefficient transportation of the injured; the second is the lack of qualified vascular surgeons, followed by a significant number of redo procedures and by poor functionality following vascular trauma. In the majority of cases with vascular injuries, an open surgical repair is most commonly necessary. On the other hand, in most developed countries, residents and young vascular surgeons do not have any experience in the treatment of vascular trauma; and education and training in open vascular surgery is essential. Young vascular surgeons and residents in Serbia do not lack this training.

We sought to analyze the early results of civil and war peripheral arterial injury treatment and to identify risk factors associated with limb loss. Between 1992 and 2001, data collected retrospectively and prospectively on 413 patients with 448 peripheral arterial injuries were analyzed. Of these, there were 140 patients with war injuries and 273 patients with civil injuries. The mechanism of injury was gunshot in 40%, blunt injury in 24%, explosive trauma in 20.3%, and stabbing in 15.7% of the cases. The most frequently injured vessels were the femoral arteries (37.3%), followed by the popliteal (27.8%), axillary and brachial (23.5%), and crural arteries (6.5%). Associated injuries, which included bone, nerve, and remote injuries affecting the head, chest, or abdomen, were present in 60.8% of the cases. Surgery was carried out on all patients, with a limb salvage rate of 89.1% and a survival rate of 97.3%. In spite of a rising trend in peripheral arterial injuries, our total and delayed amputation rates remained stable. On statistical analysis, significant risk factors for amputation were found to be failed revascularization, associated injuries, secondary operation, explosive injury, war injury (p lt .01) and arterial contusion with consecutive thrombosis, popliteal artery injury, and late surgery (p lt .05). Peripheral arterial injuries, if inadequately treated, carry a high amputation rate. Explosive injuries are the most likely to lead to amputations, whereas stab injuries are the least likely to do so. The most significant independent risk factor for limb loss was failed revascularization.