Outcomes of Revascularization and Factors Associated With Major Amputation in Patients With Lower Limb Arterial Injury: A Single-Center Retrospective Analysis.

Najam U Din,Khalil Ur Rehman,Ghulam Ali,Syed Arsalan Ahmed Naqvi,Waryam Muhammad Saleh,Muhammad Fahad Berlas

doi:10.7759/cureus.17290

Abstract

ObjectiveTo identify the amputation rates and causative factors for failed revascularization leading to amputation in patients undergoing primary limb salvage procedures for lower-extremity vascular injuries.MethodsThis retrospective study was conducted at the vascular surgery department, Shaheed Mohtarma Benazir Bhutto (SMBB) Institute of Trauma, Karachi, Pakistan. The data were collected from hospital record using the non-probability sampling technique. Patients aged 17-70 years, undergoing primary revascularization during April 2016 to March 2021, were included in the study. Patients with crush injuries/non-salvageable limbs underwent primary amputation, isolated deep femoral artery or crural arteries (non-limb threatening) injuries, and non-traumatic injuries like intravenous drug-induced or iatrogenic injuries were excluded. The data analysis is done using SPSS Version 20.0 (IBM Corp., Armonk, NY, USA). A P-value of <0.05 was considered as significant.ResultsThis study includes 56 patients of mean age 30.82 ± 9.29 years with male gender four times more affected than their counterpart. About 32% of patients were smokers, while 58% of patients had no co-morbidities. All patients presented with a mean time of 7.66 ± 1.69 hours of injury with an average of 1.14 arterial segments involved. The most frequent artery involved was popliteal artery (both above and below the knee), followed by superficial femoral artery injury constituting 50% and 26%, respectively, with arterial laceration and transection being common findings on exploration. Out of 56 patients, 27 (48.2%) had open fractures, 21 (37.5% ) closed fractures, and eight patients (14.3 % ) presented with dislocation as associated injuries. Following the procedure, secondary amputation was recorded in 18 (32.1%) patients. Thrombosis and infection were the leading causes of revascularization failure. Type of injury, segment of arterial injury, and associated bony injuries were associated with limb amputation.ConclusionType and site of injury along with concomitant bony injuries are associated with major amputations after revascularization in lower-extremity arterial injuries.

Highlights

In this contemporary era, the most common cause of morbidity and mortality is from traumatic injuries affecting the young to middle age population, posing a huge burden on any nation’s overall economy
Segment of arterial injury, and associated bony injuries were associated with limb amputation
Popliteal artery is injured in about 0.2% of all traumatic peripheral injuries and is almost always associated with bony and soft tissue injuries, and it leads to poor functional outcomes and

Summary

Introduction

The most common cause of morbidity and mortality is from traumatic injuries affecting the young to middle age population, posing a huge burden on any nation’s overall economy. Popliteal artery is injured in about 0.2% of all traumatic peripheral injuries and is almost always associated with bony and soft tissue injuries, and it leads to poor functional outcomes and. How to cite this article Ali G, Berlas M, Din N U, et al (August 18, 2021) Outcomes of Revascularization and Factors Associated With Major Amputation in Patients With Lower Limb Arterial Injury: A Single-Center Retrospective Analysis. The main objective of surgical intervention is to salvage the injured limb by revascularization and achieve a functional limb Sometimes this intervention can result in devastating complications such as reperfusion injury and compartment syndrome, compared to an early amputation and rehabilitation [5,6]; proper patient selection and timely intervention is the key to achieve desirable outcomes in terms of functional limb

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