Lower extremity arterial injury: Results of 550 cases and review of risk factors associated with limb loss

Citation
Hm. Hafez et al., Lower extremity arterial injury: Results of 550 cases and review of risk factors associated with limb loss, J VASC SURG, 33(6), 2001, pp. 1212-1219
Citations number
20
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
JOURNAL OF VASCULAR SURGERY
ISSN journal
0741-5214 → ACNP
Volume
33
Issue
6
Year of publication
2001
Pages
1212 - 1219
Database
ISI
SICI code
0741-5214(200106)33:6<1212:LEAIRO>2.0.ZU;2-#
Abstract
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.