Risk factors for major amputation after arterial vascular trauma of the lower extremity

Abstract

Background & objective: Arterial vascular trauma bears a great risk of poor functional outcome or limb loss. The aim of this study was to analyze amputation rates of patients after vascular trauma and to perform a predictor analysis for the risk of major amputation. Methods: In a single-center retrospective analysis of 119 extremities treated for arterial vascular injury between 1990 and 2018 amputation rates and factors associated with limb loss were assessed. All patients were treated for traumatic vascular injuries; iatrogenic injuries were not included in the study. Results: During the study period, a total of 119 legs in 118 patients were treated after arterial vascular trauma. The in-hospital major amputation rate was 16.8% and the mortality rate was 2.5%. In the predictors analysis, vascular re-operation (amputation rate 53.8% vs 12%, odds ratio = 8.56), a Rutherford category ⩾IIb (25.4% vs 4.2%, odds ratio = 6.43), work-related or traffic accidents (28.2% vs 0%, odds ratio = 4.86), concomitant soft tissue or bone injuries (26.7% vs 7.3%, odds ratio = 4.64), polytrauma (33.3% vs 12%, odds ratio = 3.68), and blunt trauma (18.9% vs 0% for penetrating trauma, odds ratio = 1.64) were found to be associated with amputation. Conclusions: Lower extremity arterial vascular trauma was associated with a significant major amputation rate. Several predictors for limb loss were identified, which could aid in identifying patients at risk and adapting their treatment.

Outcomes Following Below Knee Arterial Trauma

“…Many prior studies have documented risk factors for amputation including soft tissue injury, open fracture, nerve injury as well as blunt mechanism of trauma. [1][2][3][5][6][7][8][9][10] Our study shows similar patterns including open fracture and blunt mechanism. Signs of ischemia on presentation (absent Doppler signals) were also associated with amputation in our study.…”

“…13 All patients who underwent amputation due to arterial bypass graft thrombosis presented with signs of ischemia and multiple tibial vessel injuries which have been noted to be risk factors for amputation in prior studies. [1][2][3]7 Urrecehga et al reported a 12% revascularization failure rate resulting in amputation in patients with traumatic lower extremity arterial injury. 14 Five of our patients presented with signs of ischemia (absent Doppler signals and pulse).…”

“…1 Previous studies have cited polytrauma, blunt mechanism of injury, vascular reoperation as well as injury to multiple tibial vessels as risk factors for amputation. [2][3][4] Most of the literature describes outcomes regarding vascular injury from below the inguinal ligament; however, there is limited data regarding the outcomes for patients specifically with injuries to tibial arteries. Our study examines the management and clinical outcomes following traumatic vascular injury to vessels below the knee.…”

Đánh Giá Kết Quả Sớm Điều Trị Tổn Thương Động Mạch Khoeo Trong Gãy Xương Vùng Gối Tại Bệnh Viện Đa Khoa Trung Ương Cần Thơ Từ Năm 2021 Đến Năm 2023

“…Điều này cũng tương đồng với nghiên cứu của tác giả Hoàng Anh Công (2020) ghi nhận kết quả điều trị trên 33 bệnh nhân chấn thương động mạch khoeo có 93,95% bệnh nhân không ghi nhận biến chứng sau mổ [9]. Nghiên cứu của tác giả Kluckner M năm 2022 trên 118 bệnh nhân ghi nhận tỉ lệ cắt cụt chi là 16,8% [10].…”