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Single Forearm Vessel Injury in a Perfused Hand: Repair or Ligate? A Systematic Review.

Background
The purpose of this study was to systematically review available literature reporting vessel patency and how this correlates with cold symptoms following the treatment of a single forearm artery injury when the hand remains perfused. The outcomes of those treated by ligation were compared to those treated with vessel repair.


Methods
Electronic databases including PubMed, Embase (Elsevier) and Cochrane Central Register of Controlled Trials (Willey) were searched for studies that reported the outcomes of patients who underwent either ligation or repair of single vessel injuries to hands that remained perfused at time of presentation. Level of evidence was determined by two independent reviewers. Studies were then sorted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and application of inclusion and exclusion criteria. A total of 19 studies were included for statistical analysis. The patency of repaired vessels was calculated (with comparison between those with radial versus ulnar repair) as was the prevalence of cold symptoms in both ligation (or repairs that went on to occlusion) and repair groups.


Results
The average patency of radial and ulnar artery repairs was 68.39% and 65.56% respectively. There was no significant difference between the success rates of these repair groups (pooled estimates for odd ratios was 1.02, p=0.867). The average incidence of cold symptoms in those who underwent ligation (or repair that when on to occlusion) and those that had patent repairs were 19.82% and 17.27% respectively. There was no significant difference between the incidence of cold symptoms between these groups (pooled estimate for proportion of patients with cold symptoms was 0.223, p=0.573).


Conclusions
This review showed there to be no significant difference in patency of isolated radial or ulnar artery repairs. There was also no significant difference in the prevalence of cold sensitivity in patients who underwent vessel ligation compared to those who underwent repair (and subsequently remained patent). These results support the conclusion of there being no clear benefit to attempting repair of a single vessel, although further studies are needed given the often incomplete reporting of clinical outcomes in this patient population. Additionally, though a cost-benefit analysis was not included in this review, exploring this aspect of the decision making process could be valuable.Level of Evidence: IV.