A 5-year review of management of lower extremity arterial injuries at an urban level I trauma center

Abstract

Listen

Translate article

The purpose of this study was to review the management of lower extremity arterial injuries to determine incidence, assess the current management strategy, and evaluate hospital outcome. This was a retrospective review, including trauma database query, and medical records review set in an urban level I trauma center. Sixty-five patients with 75 lower extremity arterial injuries were admitted between April 2005 and April 2010. The interventions were primary amputation, medical management, vascular surgical intervention, and subsequent amputation. The main outcome measures were age, gender, race, mechanism of injury, type of injury, associated lower extremity injuries, concomitant injuries, Injury Severity Score, Abbreviated Injury Scale, surgical procedures and interventions, limb salvage rate, mortality, length of stay, and discharge disposition. During a 5-year period, 65 patients with 75 lower extremity arterial injuries were admitted to the hospital, yielding an incidence of 0.39% among trauma admissions. The study population was comprised primarily of young men, with a mean Injury Severity Score of 15.2 and a mean Abbreviated Injury Scale of 2.7 (moderate to severe injuries). The majority of patients (78.4%) suffered concomitant lower extremity injuries, most frequently bony or venous injuries, whereas 35.4% experienced associated injuries to other body regions. The most common injury mechanism was a gunshot wound (46.7%). Arterial injuries were categorized into 42 penetrating (56.0%) and 33 blunt mechanisms (44.0%). Involved arterial distribution was as follows: 4 common femoral (5.3%), 4 profunda femoris (5.3%), 24 superficial femoral (32.0%), 16 popliteal (21.3%), and 27 tibial (36.0%) arteries. The types of arterial injuries were as follows: 28 occlusion (37.3%), 23 transection (30.7%), 16 laceration (21.3%), and 8 dissection (10.7%). Orthopedic surgeons performed amputations as primary procedures in 3 patients (4.6%). The majority (76.8%) of injuries receiving vascular management underwent surgical intervention, with procedure distribution as follows: 26 bypass (49.1%); 13 primary repair (24.5%); 7 ligation (13.2%); 4 endovascular (7.5%); and 3 isolated thrombectomy (5.7%) procedures. Concomitant venous repair and fasciotomy were performed in 22.4% and 38.2% of cases, respectively. Medication was the primary strategy for 16 arterial injuries (23.2%). Subsequent major amputation was required for 3 patients (4.8%) who initially received vascular management. Three patients (4.6%) died during hospitalization. The current multidisciplinary team management approach, including use of computed tomographic or conventional angiography and prompt surgical management, resulted in successful outcomes after lower extremity arterial injuries and will continue to be utilized.