Vascular Injury Patterns in High-Energy Trauma: A Systematic Review of Incidence, Diagnostic Modalities, and Management Strategies.

Vascular injuries in high-energy trauma are life- and limb-threatening emergencies, requiring prompt diagnosis and intervention. This systematic review included five studies published between 2019 and 2023, comprising approximately 480 patients. A literature search of PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library was conducted using keywords such as "vascular injury," "high-energy trauma," "CT angiography," and "endovascular repair." Most studies focused on extremity injuries, particularly involving the femoral, popliteal, iliac, and brachial arteries. CT angiography (CTA) consistently demonstrated superior diagnostic accuracy compared to Doppler ultrasonography or clinical examination. Endovascular techniques, such as stenting and embolization, were compared with open surgical repair. Outcomes assessed included amputation rates, limb salvage, mortality, and hospital stay. Endovascular methods showed potential benefits in reducing complications and hospital duration in selected patients. Common pathophysiological patterns included arterial disruption, thrombosis, and ischemia-reperfusion injury. However, none of the studies evaluated renal outcomes. The included studies were assessed for risk of bias using ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) and the Newcastle-Ottawa Scale (NOS), revealing moderate quality overall. These findings highlight the diagnostic value of CTA and suggest a growing role for endovascular management in high-energy vascular trauma. Further high-quality studies are needed to guide treatment selection and optimize outcomes.