Outcomes and factors associated with mortality in traumatic iliofemoral vascular injuries: a contemporary three-year review from a level 1 trauma facility

Background Iliofemoral vascular injuries are associated with substantial mortality and morbidity, particularly in the context of penetrating trauma, haemorrhagic shock, and concomitant truncal injury. This study evaluated outcomes and factors associated with mortality in patients presenting with traumatic iliofemoral vascular injuries to a high-volume urban trauma centre. Methods A retrospective cohort study was conducted at a Level 1 trauma facility in South Africa, from January 2022 to December 2024. Adults with traumatic iliac or femoral vascular injuries were included. Demographic characteristics, admission physiology, biochemical markers, injury patterns, operative details, and in-hospital outcomes were analysed. Survivors and non-survivors were compared using univariable analysis. Results Eighty patients were included. The cohort was predominantly young male patients (98.8%) with a median age of 32 years, and penetrating trauma accounted for most injuries (87.5%), primarily gunshot wounds. Femoral vessel injuries were more common (n = 66) than iliac injuries (n = 14), with the femoral artery most frequently involved. High-grade vascular injury was common across both survivors and non-survivors. Overall in-hospital mortality was 11.3% (9/80) but was substantially higher in iliac vessel injuries compared with femoral injuries. Mortality was associated with physiological derangement on presentation, including lower pH (p = 0.028), reduced bicarbonate (p = 0. 005), elevated lactate (p = 0.005), and more negative base excess (p < 0.001). Non-survivors also demonstrated significantly higher rates of concomitant intra-abdominal injury (77.8% vs 12.7%, p < 0.001). Conclusion In hospital mortality in traumatic iliofemoral vascular injury is driven primarily by physiological collapse and associated intra-abdominal trauma rather than vascular injury extent alone. Iliac vessel injuries confer markedly higher risk due to anatomical and associated injury burden. Admission lactate, bicarbonate, and base deficit may reflect severe physiological derangement associated with mortality. Once initial resuscitation is survived, limb salvage outcomes are favorable with contemporary vascular repair strategies.