Impact of a Dedicated Vascular Surgery Service on Amputation Rates in Trauma Patients with Extremity Vascular Injuries

Objective: To evaluate the impact of implementing a dedicated vascular surgery service on limb salvage rates in patients with extremity vascular trauma at a Level I trauma center. Methods: This retrospective cohort study included patients aged 18 years with acute upper or lower extremity arterial injuries treated at University Medical Center of El Paso from April 2016 to April 2025.Patients were divided into pre-vascular surgery service (2016-2021) and postvascular surgery service (2021-2025) cohorts.The primary outcome was limb salvage, defined as avoidance of amputation during index hospitalization or follow-up.Secondary outcomes included time to revascularization, fasciotomy rates, anticoagulation use, and complications.Data were analyzed using chi-square tests, with significance set at P < .05. Results:Of 110 patients (mean age 35.5 15.8 years; 86.4% male), 51 were treated pre-vascular service and 59 post-vascular service.Penetrating injuries were more common pre-vascular service (64.7% vs. 42.4%;P < .05).Amputation rates decreased significantly from 13.7% (7/51) pre-vascular service to 3.4% (2/59) post-vascular service (P = .049).Injury Severity Scores (13.3 7.1 vs. 13.6 8.2, P = .84)and Mangled Extremity Severity Scores (5.2 1.6 vs. 5.3 2.1, P = .78)were similar between groups.Vascular surgeons performed all repairs in the post-vascular cohort, with increased use of bypass (21 vs. 14; P = .415)and endovascular techniques. Conclusion:Implementation of a dedicated vascular surgery service was associated with a significant reduction in amputation rates in patients with extremity vascular injuries, highlighting the critical role of specialized vascular care in trauma centers.