Contemporary outcomes of lower extremity vascular repairs extending below the knee: A multicenter retrospective study

Gerald Fortuna, Joseph J. DuBose, Ranan Mendelsberg, Kenji Inaba, Ansab Haider, Bellal Joseph, David Skarupa, Matthew J. Selleck, Thomas A. O'Callaghan, Kristofer Charlton-Ouw

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Objectives: To determine the outcomes of vascular injury interventions extending below the knee. METHODS: Vascular injury repairs extending below the knee from January 2008 to December 2014 were collected from six American College of Surgeons Level I trauma centers. Demographics, management, and outcomes were collected and analyzed. RESULTS: A total of 194 vascular injuries were identified. The mean age was 33.7 years, with 88.1% male, and 71.1% had blunt injury. Admission systolic blood pressure was less than 90 mm Hg in 10.8%; prehospital tourniquets were used in 5.6%. Median mangled extremity severity score (MESS) was 6.0 [interquartile range, 6]. Imaging used included computed tomography angiography (58.2%) and angiography (7.2%); with 66 (34.0%) proceeding directly to OR based on examination alone. Vascular interventions were conducted primarily by vascular (66.0%) and trauma (25.3%) surgeons at a median time from injury of 8 hours (interquartile range, 7 hours). Initial interventions included graft interposition (57.7%) with saphenous vein (111) or synthetic graft (1), primary repair (14.9%), endovascular stent-graft (1.5%), and patch angioplasty (2.1%). Fasciotomy was performed at initial operation in 41.8%, and for delayed compartment syndrome in 2.1%. Vascular reintervention was required in 20 patients (6.7%) for bleeding (seven patients) or thrombosis (13 patients). There was a higher reintervention rates for thrombosis among interposition grafts with distal anastomotic sites at the below-knee popliteal compared to those extending to the tibioperoneal trunk or distal trifurcation vessels, but this was not significant. (4/60, 6.7% vs. 6/49, 12.2%; p = 0.34). Postintervention amputation rates were significantly higher among interposition grafts extending distal to the popliteal (4/60 [6.7%] vs. 15/49 [30.6%]; p = 0.006). CONCLUSIONS: The management of vascular injuries extending below the knee remains a complex issue of extremity trauma care. The need for delayed amputation is significantly more common when revascularization below the distal popliteal artery is required.

Original languageEnglish (US)
Pages (from-to)63-69
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume81
Issue number1
DOIs
StatePublished - 2016

Keywords

  • Amputation
  • Below the knee
  • Limb salvage
  • Lower extremity vascular repairs

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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    Fortuna, G., DuBose, J. J., Mendelsberg, R., Inaba, K., Haider, A., Joseph, B., Skarupa, D., Selleck, M. J., O'Callaghan, T. A., & Charlton-Ouw, K. (2016). Contemporary outcomes of lower extremity vascular repairs extending below the knee: A multicenter retrospective study. Journal of Trauma and Acute Care Surgery, 81(1), 63-69. https://doi.org/10.1097/TA.0000000000000996