Purpose: We sought to analyze the results of lower limb arterial injury (LL
AI) management in a busy metropolitan vascular unit and to identify risk fa
ctors associated with limb loss.
Patients and Methods: Between 1987 and 1997, prospectively collected data o
n 550 patients with 641 lower limb arterial injuries were analyzed.
Results: The mechanism of LLAI was gunshot wounds in 46.1%, blunt in 19%, s
tabbing in 11.8%, and shotgun in 9.1%. The most frequently injured vessel w
as the superficial femoral artery (37.2%), followed by tile popliteal (30.7
%), crural (11%), common femoral (8.7%), and deep femoral (5.3%) arteries.
In 3.4% of cases, there was a combined injury on either side of the knee (i
psilaterally). Associated injuries included bony injury in 35.1% of cases,
nerve injury in 7.6%, and remote affecting the head, chest, or abdomen in 3
.6%. Surgery was carried out on 96.2% of cases with a limb salvage rate of
83.8% and a survival of 98.5%. In spite of a rising trend in LLAI, am total
and delayed amputation rates remained stable. On stepwise logistic regress
ion analysis, significant (P < .01) independent risk factors far amputation
were occluded graft (odds ratio [OR] 16.7), combined above- and below-knee
injury (OR 4.4), tense compartment (OR 4.2), arterial transsection (OR 2.8
), and associated compound fracture (OR 2.7).
Conclusion: LLAI carries a high amputation rate. Stab injuries are the leas
t likely to lead to amputations, whereas highvelocity firearm injuries are
the most likely to do so. The most significant independent risk facter for
limb loss was failed revascularization.