Pattern, Management and Outcomes of Vascular Trauma at Kenyatta National Hospital

Abstract

BACKGROUND: Major Vascular Trauma (VT) either iatrogenic or non-iatrogenic is increasingly encountered in KNH but is largely under reported. Vascular trauma management has evolved from simple ligation, a practice that resulted in unsatisfactory outcomes to modern open and endoluminal interventions that offer excellent outcomes(1). Information regarding the injury patterns and presentation in the setting of trauma is crucial in making decisions concerning surgical techniques deployed and predicting the chances of limb salvage. OBJECTIVE: To determine the pattern, management, and surgical outcomes of VT in patients admitted at Kenyatta National Hospital (KNH). METHODOLOGY: This was a cross-sectional, 10-year retrospective investigation conducted at KNH. The study included patients who were brought to KNH between January 2013 and December 2022 with VT either as an independent injury or in the context of polytrauma. Patients who met the inclusion criteria were selected using consecutive sampling and data obtained thereafter recorded in a data collection tool. Data collected was entered and analyzed using Stata version 15. The patterns and outcomes are also summarized in the form of frequencies and percentages. RESULTS Our analysis focused on demographics, clinical characteristics and outcomes. The majority of our patients (49%) were between the ages of 21 to 40 years with a predominantly male demographic (94%). Penetrating trauma was the most common injury accounting for 79% while arterial injuries accounted for 63% of the cases. In terms of anatomy, the left leg and right arm were common sites for injuries accounting for 32% and 23% respectively. The majority (68%) of patients presented more than 6 hours after the injury. Treatment varied with repairs accounting for 46% and ligations 27%. Our outcomes showed an 81% limb salvage rate, while 17% resulted in amputation, and 3% ended in death. Age-related outcomes indicated higher amputation and death rates in age groups of 31yrs to 44yrs. Associations reveal that blunt injuries had the highest amputation (50%) and death (10%). Penetrating injuries were more likely to result in limb salvage (89%). Arterial injuries had the highest amputation rate (20%). x DISCUSSION Our study at Kenyatta National Hospital reveals comparable vascular repair rates in highincome countries. Timely intervention, especially within 6 hours is crucial for limb salvage. This necessitates improving access to early surgical intervention through optimized trauma triage and resource availability. Factors like age and mechanism of injury necessitate tailored treatment strategies. Educational campaigns targeting high-risk demographics particularly young males can mitigate injury incidence. Early recognition of signs is essential to prevent delayed presentation. Overall a comprehensive approach to trauma care including timely intervention, multidisciplinary collaboration and tailored treatment can enhance outcomes and alleviate the burden of traumatic vascular injuries in Kenya