Outcomes of upper limb vascular injuries at Charlotte Maxeke Johannesburg Academic Hospital South Africa (2021–2023)

Abstract

Purpose This study evaluates upper limb vascular injuries (ULVIs) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH, South Africa) to describe clinical features, in-hospital outcomes, and factors associated with poor outcomes. Methods A retrospective cohort study analyzed 79 suspected ULVI cases from January 1, 2021 to December 31, 2023, of which 74 had confirmed arterial injuries. Data on demographics, mechanism of injury, artery involved, American Association for the Surgery of Trauma (AAST) grades, treatments, and outcomes were collected from medical records. Poor outcomes were defined as postoperative complications (infection, thrombosis, graft failure) or amputations. Adjunct procedures (fasciotomy, nerve repair) were analyzed separately as markers of injury complexity. No ischemia time or shunt use data were recorded. Results Of 74 patients (91% male, mean age 33.5 years, SD 9.5), penetrating injuries (91%) included gunshot wounds (GSWs, 50%; 37/74) and stabs (41%; 30/74); nonpenetrating injuries (9%) included various mechanisms ( n = 7). Brachial artery injuries predominated (72%), followed by axillary (23%) and subclavian (5%). AAST grade V injuries were most common (58%). Reverse saphenous vein graft (39%) and primary repair (34%) were frequent treatments. Outcomes included successful repairs (82%), postoperative complications (14%), and amputations (4%). GSWs were associated with poor outcomes ( p = 0.01 among penetrating cases). Sensitivity analysis confirmed associations with GSWs ( p = 0.015), AAST grades IV and V ( p < 0.001), and reverse saphenous vein graft ( p = 0.005). Conclusions CMJAH's ULVI profile, dominated by GSWs and stabs, reflects urban violence in a low- and middle-income country setting. The 4% amputation rate is comparable to high-income country benchmarks, though limited by small sample size, retrospective design, and lack of ischemia time data.