Revascularization Strategies for Post-Traumatic Delayed Limb Ischemia: Outcomes and Challenges

Abstract

Delayed limb ischemia following trauma, which becomes apparent or is treated at least 24 hours post-injury, has a high risk of reperfusion injury, infection, and amputation. The study examined outcomes of different revascularization techniques and determined what factors affect limb salvage.

This was a cross-sectional study of 103 patients who had been treated for post-traumatic limb ischemia in hospitals in Baghdad, Iraq, in the period between June 2025 and June 2026. The primary outcome was limb salvage, and the secondary outcomes were luminal patency (primary and secondary), complications, and mortality.

In addition, among the people examined, 75.7% had involvement of the lower limbs and 79.6% had fractures that also occurred. The average time of injury until revascularization was 3.2 days. The most popular method of surgery was the reversed interposition of the great saphenous vein (39.8%). The primary (30 days) and secondary (30 days) patency were 84.5% and 93.2%, respectively, with limb salvage in 30 days constituting 91.3%. The most commonly encountered complications were reperfusion injury (16.5%) and surgical site infection (18.4%); the mortality rate at 30 days was 2.9%. At the median follow-up, limb salvage after 16 months was found to be 88.3%, while the Kaplen-Meier limb salvage was 95.2%, 85.0%, and 71.3% in the case of revascularization conducted within 72 hours, between 3 and 7 days, and after 7 days, respectively.

Revascularization is able to salvage the majority of limbs in the case of post-traumatic ischemia, but the outcomes are worsening with time passing and soft-tissue injury or infections becoming graver