Femoral vessel injuries: analysis of factors predictive of outcomes

Abstract

Conclusion: There is both a high survival and complication rate for treatment of femoral vessel injuries. Summary: This was a retrospective study of patients admitted during a 132-month period (January 1, 1992 through December 31, 2002) at a large level 1 urban trauma center. Univariant and multivariant analysis were used to determine predictors of outcome after femoral vessel injury. There were 204 patients with 298 vessel injuries consisting of 204 arterial and 94 venous injuries. Mean patient age was 29 ± 13 years. Mean injury severity score was 17 ± 8. Eighty-six percent of injuries (n = 176) were penetrating, and 14% (n = 28) were blunt injuries. Numerous techniques were used for both arterial and venous repairs. In arterial repairs, reverse saphenous vein grafts were used in 53%. Primary repair of the injury was performed in 26%. A polytetrafluoroethylene graft was placed in 10.2%. The femoral vessel was ligated in 6.4%. With respect to femoral venous injuries, 52% were ligated, 44% underwent primary repair, and 4% underwent bypass. Twenty-seven percent of the patients underwent fasciotomy of the calf, and 12% underwent fasciotomy of the thigh. There were six acute amputations and no delayed amputations. Overall survival was 91%; when emergency department thoracotomy deaths were excluded, adjusted survival was 95%. Complications occurred in 47 patients (23%). The most common complication was wound infection (n = 31), followed by venous thrombosis (n = 6). Arterial thrombosis occurred in only one patient. Predictors of postoperative complication included interoperative hypertension, arterial injury, long bone facture, and thoracic injury. Predictors of mortality were age >45 years, injury severity score >25, common femoral artery injury, and the combination of venous and abdominal injuries. Comment: Reports such as this do not provide much in the way of new insights. Predictors of mortality, complications, and the types of complications are what one would expect. It is interesting, however, to note the very high survival rate for patients with such injuries treated in a level 1 trauma center.