Factors Associated with Amputation after Popliteal Vascular Injuries

Jessica Keeley, Matthew Koopman, Huan Yan, Christian DeVirgilio, Brant Putnam, Dennis Y. Kim, David Plurad

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Popliteal artery trauma has the highest rate of limb loss of all peripheral vascular injuries. The objectives of this study were to evaluate outcomes after popliteal vascular injury and to identify predictors of amputation. Methods Retrospective data over a 14-year period were collected for patients with popliteal artery with or without vein injuries. Patient demographics, mechanism of injury, Injury Severity Score (ISS), Mangled Extremity Severity Score (MESS), and physiologic parameters were extracted. Time to operative intervention, operative time, type of vascular repair, need for concomitant orthopedic procedures, and outcomes including amputation rate, and in-hospital mortality were recorded. Results Fifty-one patients were found to have popliteal artery injuries, with a median age of 25 (range 10–70 years). The median ISS was 9, and the mean extremity Abbreviated Injury Severity score was 3. The mechanism of injury was blunt for 43% and penetrating for 57%. Fasciotomies were performed in 74% of patients and 64% of patients underwent combined orthopedic and vascular procedures. Overall, 66% of these patients had their vascular procedure performed first. Ten patients required amputation: 1 immediate and 9 after attempted limb salvage (20%). We found that those patients requiring amputation had a higher incidence of blunt trauma (80% vs. 35%, P = 0.014) and higher MESS score (7.1 vs. 4.7, P = 0.02). There was no difference in the incidence of amputation for those who underwent orthopedic fixation before vascular repair (P = 0.68). Conclusions Popliteal vascular injuries continue to be associated with a high risk of amputation. Those patients undergoing attempted limb salvage should be revascularized expediently, but selected patients may undergo orthopedic stabilization before vascular repair without increased risk of limb loss.

Original languageEnglish (US)
Pages (from-to)83-87
Number of pages5
JournalAnnals of Vascular Surgery
Volume33
DOIs
StatePublished - May 1 2016
Externally publishedYes

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Vascular System Injuries
Amputation
Blood Vessels
Extremities
Popliteal Artery
Injury Severity Score
Orthopedic Procedures
Wounds and Injuries
Limb Salvage
Operative Time
Orthopedics
Nonpenetrating Wounds
Incidence
Hospital Mortality
Veins
Demography

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Factors Associated with Amputation after Popliteal Vascular Injuries. / Keeley, Jessica; Koopman, Matthew; Yan, Huan; DeVirgilio, Christian; Putnam, Brant; Y. Kim, Dennis; Plurad, David.

In: Annals of Vascular Surgery, Vol. 33, 01.05.2016, p. 83-87.

Research output: Contribution to journalArticle

Keeley, J, Koopman, M, Yan, H, DeVirgilio, C, Putnam, B, Y. Kim, D & Plurad, D 2016, 'Factors Associated with Amputation after Popliteal Vascular Injuries', Annals of Vascular Surgery, vol. 33, pp. 83-87. https://doi.org/10.1016/j.avsg.2016.02.004
Keeley, Jessica ; Koopman, Matthew ; Yan, Huan ; DeVirgilio, Christian ; Putnam, Brant ; Y. Kim, Dennis ; Plurad, David. / Factors Associated with Amputation after Popliteal Vascular Injuries. In: Annals of Vascular Surgery. 2016 ; Vol. 33. pp. 83-87.
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abstract = "Background Popliteal artery trauma has the highest rate of limb loss of all peripheral vascular injuries. The objectives of this study were to evaluate outcomes after popliteal vascular injury and to identify predictors of amputation. Methods Retrospective data over a 14-year period were collected for patients with popliteal artery with or without vein injuries. Patient demographics, mechanism of injury, Injury Severity Score (ISS), Mangled Extremity Severity Score (MESS), and physiologic parameters were extracted. Time to operative intervention, operative time, type of vascular repair, need for concomitant orthopedic procedures, and outcomes including amputation rate, and in-hospital mortality were recorded. Results Fifty-one patients were found to have popliteal artery injuries, with a median age of 25 (range 10–70 years). The median ISS was 9, and the mean extremity Abbreviated Injury Severity score was 3. The mechanism of injury was blunt for 43{\%} and penetrating for 57{\%}. Fasciotomies were performed in 74{\%} of patients and 64{\%} of patients underwent combined orthopedic and vascular procedures. Overall, 66{\%} of these patients had their vascular procedure performed first. Ten patients required amputation: 1 immediate and 9 after attempted limb salvage (20{\%}). We found that those patients requiring amputation had a higher incidence of blunt trauma (80{\%} vs. 35{\%}, P = 0.014) and higher MESS score (7.1 vs. 4.7, P = 0.02). There was no difference in the incidence of amputation for those who underwent orthopedic fixation before vascular repair (P = 0.68). Conclusions Popliteal vascular injuries continue to be associated with a high risk of amputation. Those patients undergoing attempted limb salvage should be revascularized expediently, but selected patients may undergo orthopedic stabilization before vascular repair without increased risk of limb loss.",
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AU - Keeley, Jessica

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AU - Yan, Huan

AU - DeVirgilio, Christian

AU - Putnam, Brant

AU - Y. Kim, Dennis

AU - Plurad, David

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N2 - Background Popliteal artery trauma has the highest rate of limb loss of all peripheral vascular injuries. The objectives of this study were to evaluate outcomes after popliteal vascular injury and to identify predictors of amputation. Methods Retrospective data over a 14-year period were collected for patients with popliteal artery with or without vein injuries. Patient demographics, mechanism of injury, Injury Severity Score (ISS), Mangled Extremity Severity Score (MESS), and physiologic parameters were extracted. Time to operative intervention, operative time, type of vascular repair, need for concomitant orthopedic procedures, and outcomes including amputation rate, and in-hospital mortality were recorded. Results Fifty-one patients were found to have popliteal artery injuries, with a median age of 25 (range 10–70 years). The median ISS was 9, and the mean extremity Abbreviated Injury Severity score was 3. The mechanism of injury was blunt for 43% and penetrating for 57%. Fasciotomies were performed in 74% of patients and 64% of patients underwent combined orthopedic and vascular procedures. Overall, 66% of these patients had their vascular procedure performed first. Ten patients required amputation: 1 immediate and 9 after attempted limb salvage (20%). We found that those patients requiring amputation had a higher incidence of blunt trauma (80% vs. 35%, P = 0.014) and higher MESS score (7.1 vs. 4.7, P = 0.02). There was no difference in the incidence of amputation for those who underwent orthopedic fixation before vascular repair (P = 0.68). Conclusions Popliteal vascular injuries continue to be associated with a high risk of amputation. Those patients undergoing attempted limb salvage should be revascularized expediently, but selected patients may undergo orthopedic stabilization before vascular repair without increased risk of limb loss.

AB - Background Popliteal artery trauma has the highest rate of limb loss of all peripheral vascular injuries. The objectives of this study were to evaluate outcomes after popliteal vascular injury and to identify predictors of amputation. Methods Retrospective data over a 14-year period were collected for patients with popliteal artery with or without vein injuries. Patient demographics, mechanism of injury, Injury Severity Score (ISS), Mangled Extremity Severity Score (MESS), and physiologic parameters were extracted. Time to operative intervention, operative time, type of vascular repair, need for concomitant orthopedic procedures, and outcomes including amputation rate, and in-hospital mortality were recorded. Results Fifty-one patients were found to have popliteal artery injuries, with a median age of 25 (range 10–70 years). The median ISS was 9, and the mean extremity Abbreviated Injury Severity score was 3. The mechanism of injury was blunt for 43% and penetrating for 57%. Fasciotomies were performed in 74% of patients and 64% of patients underwent combined orthopedic and vascular procedures. Overall, 66% of these patients had their vascular procedure performed first. Ten patients required amputation: 1 immediate and 9 after attempted limb salvage (20%). We found that those patients requiring amputation had a higher incidence of blunt trauma (80% vs. 35%, P = 0.014) and higher MESS score (7.1 vs. 4.7, P = 0.02). There was no difference in the incidence of amputation for those who underwent orthopedic fixation before vascular repair (P = 0.68). Conclusions Popliteal vascular injuries continue to be associated with a high risk of amputation. Those patients undergoing attempted limb salvage should be revascularized expediently, but selected patients may undergo orthopedic stabilization before vascular repair without increased risk of limb loss.

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