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Int J Angiol 2018; 27(01): 029-034
DOI: 10.1055/s-0037-1618570
Original Article
Thieme Medic al Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evaluation of Experience with Lower Extremity Arterial Injuries at an Urban Trauma Center

Christopher Tanga
1   Department of General Surgery, OhioHealth Doctors Hospital, OhioHealth Grant Medical Center, Columbus, Ohio
,
Randall Franz
2   Department of Vascular and Endovascular Surgery, OhioHealth Grant Medical Center, Columbus, Ohio
,
Joshua Hill
3   Department of Trauma and Surgical Intensive Care, OhioHealth, Grant Medical Center, Columbus, Ohio
,
Michael Lieber
1   Department of General Surgery, OhioHealth Doctors Hospital, OhioHealth Grant Medical Center, Columbus, Ohio
,
John Galante
1   Department of General Surgery, OhioHealth Doctors Hospital, OhioHealth Grant Medical Center, Columbus, Ohio
› Author Affiliations
Further Information

Publication History

Publication Date:
30 January 2018 (online)

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Abstract

Lower extremity arterial injuries (LEAIs) can be complicated injuries resulting in limb loss and death. Patients with LEAI often have multiple injuries increasing the risk for morbidity and mortality. We sought to evaluate the incidence and management of LEAI and to define associations between injuries and outcomes. We performed a retrospective review of LEAI at an urban level-1 trauma center from April 2005 to April 2015. Chi-square tests were used to compare independent groups with respect to mortality and amputation. Means were compared between independent groups using two-sample t-tests. From April 2005 to April 2015, 208 arterial injuries occurred in 163 patients. The majority (80.4%) suffered concomitant lower extremity injuries with 35.6% suffering systemic injuries. Surgical intervention was required for 72.1% of injuries. Amputation rate was 14.7%. Mortality rate was 8.0%. Data from 2010 to 2015 were more specifically analyzed. Injury severity score (ISS) was higher with fatalities (37 ± 13.16 vs. 11.8 ± 8.51, p < 0.0001) and in patients requiring an amputation (25.4 ± 15.32 compared with 11.6 ± 9.05, p = 0.0015). Popliteal artery injury was most likely to require an amputation (odds ratio [OR] = 2.9, p = 0.04). Mortality was more likely when systemic injuries were present (OR = 18.1, p = 0.0005). The majority of patients with arterial injuries require surgical management, most often with open surgical techniques. Arterial injuries associated with systemic injuries, blunt injury mechanisms, and higher ISS are at a significantly increased risk of mortality.

Keywords

trauma - lower extremity - arterial injury - fasciotomy - amputation - mortality - injury severity score
 

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