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

Hafez, Hany; Woolgar, Justin; Robbs, J V

doi:10.1046/j.1365-2168.2000.01420-2.x

Cited by 75 publications

(139 citation statements)

References 13 publications

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“…Limb salvage rates were 90.1 %. Hafez et al reported limb salvage in 84 % of patients and Razmadze et al in 77 % of patients [25,29]. Mortality due to peripheral arterial injury is rare and one patient in this study died due to myocardial infarction.…”

Section: Discussionmentioning

confidence: 73%

Peripheral Arterial Injuries: an Indian Experience

Joshi

2015

Indian J Surg

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Arterial injuries present the most challenging conditions in surgical practice. Many fail to reach the specialist in time and end up losing limbs or lives. Though well addressed elsewhere, it has received less attention in developing countries like India. There is a need to study these injuries from the perspective of countries like India. The aims of the study are to (1) analyze the epidemiology, presentation, and outcomes of arterial injuries operated by the author in Indian settings; (2) identify factors associated with adverse outcomes; and (3) discuss the critical issues with relevance to our country. Retrospective analysis of arterial injuries operated by the author between July 2010 and February 2014 at our institution was performed. Patients with feasibility of revascularization were included and nonviable limbs requiring primary amputations were excluded. Sixty-one patients fulfilled the criteria of which 55 (90.1 %) were males and 6 (9.8 %) females aged between 5 and 70 years. The mean duration of presentation was 21 h. Majority were resultant of road traffic accidents (62.7 %). Among 49 (80.3 %) noniatrogenic injuries, the mechanism was blunt in 46 (93.8 %, n=49) and penetrating in 3 (6.1 %) cases. Iatrogenic injuries were seen in 12 (19.6 %) cases. Lower limbs accounted for 37 (60.6 %) cases, popliteal segment being common, 22 (36 %) cases. Bony injuries were associated in 39 (63.9 %) cases. The most common procedure was interposition graft (49.1 %). Six (9.8 %) patients required an amputation resulting in 55 (90.1 %) salvaged limbs.Reaching a specialist center in appropriate time can result in good limb salvage rates and functional outcomes. Creating awareness and training the personnel are the critical issues in the management of arterial injuries in India.

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Section: Discussionmentioning

confidence: 73%

Peripheral Arterial Injuries: an Indian Experience

Joshi

2015

Indian J Surg

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“…[4][5][6][7] Most of the patients were young males, and the SFA is a vulnerable artery, comprising approximately 30% of all of the cases. Blunt vascular trauma of the lower extremities is associated with a high rate of limb loss.…”

Section: Discussionmentioning

confidence: 99%

“…9) However, open surgical bypasses may not always require anticoagulation therapy. 5) In clinical settings, open surgical bypasses are often performed for ischemia in the lower extremities in patients with arteriosclerosis obliterans, which partly affects anastomotic sites and distal runoff. Meanwhile, patients with vascular trauma of the lower extremities are typically young and healthy, which suggests that the vascular system is normal except for the injured area.…”

Section: Discussionmentioning

confidence: 99%

Open Surgical Bypass for Superficial Femoral Artery Occlusion Caused by Blunt Trauma

Ikeda

Kudo

Maeda

et al. 2015

Annals of Vascular Diseases

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Blunt vascular trauma of the lower extremities brings about a high amputation rate, because other organ injuries disturb revascularization. We experienced a case of a superficial femoral artery occlusion caused by blunt trauma. The patient also had a femoral bone fracture and a large skin defect with deep muscular injuries of the thigh. We performed a femoropopliteal (FP) bypass using a saphenous vein which was routed through the contaminated wound. Postoperative vacuumassisted closure therapy was used to prevent graft infection. Surgical bypasses using saphenous veins are approved treatments for arterial occlusions from blunt trauma if the grafts go through contaminated wounds.Keywords: vascular trauma, surgical bypass, emergency surgery a saphenous vein graft (SVG) which was routed through the contaminated wound. Case ReportA 30-year-old man, who injured his right leg at work with a heavy industrial machine, was transferred to our emergency department. Physical examination revealed that he was alert and conscious with a Glasgow Coma Scale score of 15. His vital signs were as follows: blood pressure, 132/80 mmHg; heart rate, 91 beats/min; and respiratory rate, 25 breaths/min. His right thigh had a crushing wound comprising a large skin defect and deep muscular injuries (Fig. 1A). Distal arterial pulses in the right leg could not be detected using a Doppler flowmeter. The patient could move his right leg, but he had lost sensation in his right leg. The result of focused assessment with sonography for trauma was negative. Computed tomography (CT) revealed a comminuted fracture of the trochanteric section of the right femoral bone, which was accompanied by injuries of the thigh muscles and subcutaneous tissue (Fig. 1B). In addition, the right SFA was occluded at the proximal portion. The peripheral arteries which were distal to the popliteal artery were visualized by collateral flow. Because the occluded site of the SFA corresponded to the crushing wound of the thigh, we considered that the arterial occlusion resulted from the intimal injury caused by the blunt trauma and not a thrombus. When the CT scan was completed, 3 h had passed since he injured his right leg. From these findings, we rated the injury severity score as 9, the probability of survival as 99.4%, and the mangled extremity severity score (MESS) as 5. 1-3) He immediately underwent an emergency surgery to salvage his limb after the imaging examination.While the patient was under general anesthesia, wound cleansing and external femoral bone fixation were performed. The right femoral artery was then exposed in the groin, and the popliteal artery was exposed above the knee via a medial approach. The great saphenous vein was harvested from the contralateral leg. After intravenous administration of heparin (5000 U), the proximal and distal

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“…The patient was discharged on the tenth day after operation with no further complication. Discussion In a series of 550 patients with 641 lower limb arterial injuries, Hafez et al found that the popliteal artery was the second most commonly injured vessel in the leg (31%) [2]. In all the three cases, different surgical approaches were performed to the patients, appropriate to the site and type of their vascular injuries.…”

Section: Casementioning

confidence: 99%

Gunshot injuries of the popliteal vessels: A report of three cases

Başbuğ¹,

Günerhan²,

Göçer³

et al. 2017

Arch Clin Exp Surg

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IntroductionLower extremity vascular injuries include gunshot wounds (GSWs), traffic accidents, penetrating injuries, blunt injuries, and industrial injuries. Major vascular injuries after GSWs may associate with different findings like bone fractures, massive bleeding, hypovolemic shock, soft tissue disruption, acute ischemia, and neurological deficit. The main predispositions for the limb loss after lower extremity GSWs are associated with various factors. These factors include the extent of tissue damage, duration of ischemia, concomitant arterial and venous involvement, and the presence of compartment syndrome [1]. In this paper, three cases with lower extremity GSWs in the popliteal region were presented. It aimed to emphasize the importance of prompt diagnosis and the management and to remind the readers of the related procedural information in the light of these cases.Case 1 A 24-year-old male patient was examined at the Emergency Department with low velocity (bullet injury) GSW on his right lower extremity. His blood pressure was 110/70 mmHg and heart rate was 120 bpm (sinus tachycardia). Distal pulses on his right lower extremity were not palpable. The musculoskeletal defect of the right popliteal region was severe, and the disruption was between the popliteal artery (POPA) and tibioperoneal artery (TPA) at the popliteal region. On the other hand, sciatic nerve and the peroneal nerve were not affected by the thermal damage. Computerized Gunshot injuries of the popliteal vessels: A report of three casesHamit Serdar Basbug, Yalcin Gunerhan, Hakan Gocer, Kanat Ozisik ABSTRACTLower extremity vascular injuries occur due to gunshot wounds, traffic accidents, penetrating and blunt injuries, or industrial injuries. Gunshot wounds with vascular injuries have been increased among the civilian population. Lower extremity gunshot wounds have severe and acute complications of bone fractures, abundant bleeding, hypovolemic shock, soft tissue disruption, acute ischemia, neurological deficit, limb loss, or even death. The amputation rate of the popliteal injuries differs between 27% and 54%. In this paper, preoperative management and surgical experience in the popliteal region vascular injuries in three massively impaired cases were presented. Different surgical approaches performed in these patients due to the variety of pathologies were also discussed.

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

Cited by 75 publications

References 13 publications

Peripheral Arterial Injuries: an Indian Experience

Peripheral Arterial Injuries: an Indian Experience

Open Surgical Bypass for Superficial Femoral Artery Occlusion Caused by Blunt Trauma

Gunshot injuries of the popliteal vessels: A report of three cases

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