Abstract

Introduction: Combat-related vascular injuries represent as major challenge in war zones, with significant risks of limb loss and mortality. Temporary arterial shunts (TAS) are frequently used as damage control strategy to restore perfusion until definitive repair can be performed. However, their outcomes may differ according to the site of injury. This study aimed to compare the outcome of using TAS for limb salvage in upper and lower extremity vascular injuries.

Methods: This is a retrospective comparative study included 65 patients with penetrating vascular injury (gunshot, pump explosion and blast injuries) between January 2023 and January 2025. Injuries were divided into upper extremity (UE) and lower extremity (LE) vascular injuries according to anatomical site of penetration. All patients were managed in Osylan Hospital in Shabwa Governorate with TAS and damage control surgery within 20 hours until patients were stabilized and transferred to the referral hospitals for definitive treatment in Ataq City.

Results: Vascular injuries of LE were higher than UE (69.2% vs. 30.8%), where brachial artery was the common affected artery in the UE (35.0%), and popliteal artery was the common affected artery in the LE (37.8%). Significant mean age difference was found between LE and UE affected patients, but no significant difference found between the mean units of blood transfusion, percentage of hematocrit, SBP at presentation, and the revascularization time. No significant association found between the type of the associated penetrating injuries and the affected extremities. The outcome of TAS showed that significant higher percentage of patency in UE than with LE (90.0% vs. 64.4%), while limb amputation was higher in LE than with UE (24.5% vs. 5.0%), and death was reported higher in patients with LE than with UE (11.1% vs. 5.0%), without significant statistical association.

Conclusion: This study concluded that TAS demonstrated higher patency in the salvage of UE than in the LE vascular injuries, which might be attributed to the differences in anatomical, physiological, surgical factors, and the associated organ injuries.

Keywords: Temporary Arterial Shunt, Vascular injuries, Extremity, Damage control surgery, Yemeni War.

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