Outcome Predictors in Traumatic Popliteal Artery Injury

Abstract

Background: In the last century, significantly reduced amputation rates in patients with traumatic popliteal artery injury have been achieved with improved revascularization techniques; however, failed revascularization remains a vexing problem for clinicians and has a devastating outcome for patients. We reviewed our experience with popliteal artery injuries at a civilian level I trauma center. The objective of the current study was to document the mechanism of popliteal artery injury, methods of repair, and to determine risk factors for amputation. Methods: From January 2002 to June 2009, 68 patients with popliteal artery injuries were identified in the trauma registry. We conducted a retrospective record review documenting age, mechanism of injury, associated orthopedic injury, venous injury, use of fasciotomy, mangled extremity severity score (MESS), and injury severity score (ISS). Univariate and multivariate analysis was performed to determine risk factors for amputation. Results: We identified 70 popliteal artery injuries in 68 patients. Median age was 33 years (range, 5-88 years), and 57 patients (81%) were male. Blunt trauma was the cause of 51 injuries (73%). Associated venous injuries were present in 16 (23%). Associated orthopedic injuries included 19 dislocations (27%) and 49 fractures (70%). The median MESS was 5 (range, 2-9) and the median ISS was 9 (range, 4-41). Fifteen patients (21%) required amputation: 8 primary (11%) and 7 secondary (10%). Revascularization was performed in 62 cases (89%). Compartment syndrome was documented in 23% of patients, and 56% underwent fasciotomy. Univariate analysis was calculated for each predictor variable. Four variables were significantly associated with amputation: MESS (odds ratio [OR], 2.44; P < .0001); ISS >10 vs ISS <9 (OR, 7.41; P < .0429); blunt injury (OR, 10.69; P = .0088), and fractures (OR, 0.13; P < .0437). By multiple exact logistic regression, MESS (P < .05) was the only significant predictor of amputation. The increased odds of amputation were similar for primary (OR, 2.60; P = .001) and secondary (OR, 2.39; P = .002) amputations. Conclusion: Patients with traumatic popliteal artery injury are at high risk for amputation. Blunt injury, associated fractures, MESS, and ISS >9 were significantly associated with amputation. MESS was a significant predictor of amputation and should be considered if revascularization is planned in these critically injured patients.