Femoral Vessel Injuries

Analysis of Factors Predictive of Outcomes

Juan A. Asensio, Eric J. Kuncir, Luis M. García-Núñez, Patrizio Petrone

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background: Femoral vessel injuries are the most common vascular injuries treated in a Level I trauma center. No studies have identified risk factors for survival and complications. Study design: We performed a retrospective, 132-month study that included univariate and multivariate analyses. Results: We studied 204 patients with 298 vessel injuries: 204 were arterial, 94 were venous. Mean age (± SD) was 29 ± 13 years and mean Injury Severity Score (± SD) was 17 ± 8. There were 176 (86%) penetrating injuries and 28 (14%) blunt injuries. Arterial repairs included: reverse saphenous vein graft bypass, 108 (53%); primary repair, 53 (26%); PTFE, 21 (10.2%); ligation, 13 (6.4%); and vein patch, 9 (4.4%). Venous repairs included: ligation, 49 (52%); primary repair, 41 (44%); and bypass, 4 (4%). Fasciotomies included: calf, 56 (27%); thigh, 25 (12%); traumatic amputations, 6 (3%); and delayed amputations, 0. Overall survival rate was 91% (186 of 204), and adjusted survival was 95% (excluding emergency department thoracotomy deaths). There were 1 or more complications in 47 (23%), including wound infection, 31 (15%); venous thrombosis, 6 (3%); bleeding, 5 (2.5%); ARDS, 4 (2%); and arterial thrombosis, 1 (0.5%). Predictors of mortality were age > 45 years, Injury Severity Score > 25, common femoral artery injury, associated venous and abdominal injury, hypotension, hypothermia, and acidosis; coagulopathy in the operating room and the need for PTFE repair also predicted outcomes. Predictors of postoperative complications were intraoperative hypotension, arterial intimal injury, bony fracture, and thoracic injury. Conclusions: Although survival and limb salvage rates are high for femoral vessel injuries, these injuries incur high complication rates. Independent predictors for mortality are: Injury Severity Score > 25, Glasgow Coma Scale 28, presence of coagulopathy in the operating room, presence of two or more vascular signs, and age > 45 years.

Original languageEnglish
Pages (from-to)512-520
Number of pages9
JournalJournal of the American College of Surgeons
Volume203
Issue number4
DOIs
StatePublished - Oct 2006
Externally publishedYes

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Thigh
Statistical Factor Analysis
Wounds and Injuries
Injury Severity Score
Polytetrafluoroethylene
Operating Rooms
Hypotension
Ligation
Traumatic Amputation
Tunica Intima
Abdominal Injuries
Thoracic Injuries
Limb Salvage
Nonpenetrating Wounds
Glasgow Coma Scale
Survival
Mortality
Trauma Centers
Vascular System Injuries
Saphenous Vein

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Femoral Vessel Injuries : Analysis of Factors Predictive of Outcomes. / Asensio, Juan A.; Kuncir, Eric J.; García-Núñez, Luis M.; Petrone, Patrizio.

In: Journal of the American College of Surgeons, Vol. 203, No. 4, 10.2006, p. 512-520.

Research output: Contribution to journalArticle

Asensio, Juan A. ; Kuncir, Eric J. ; García-Núñez, Luis M. ; Petrone, Patrizio. / Femoral Vessel Injuries : Analysis of Factors Predictive of Outcomes. In: Journal of the American College of Surgeons. 2006 ; Vol. 203, No. 4. pp. 512-520.
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abstract = "Background: Femoral vessel injuries are the most common vascular injuries treated in a Level I trauma center. No studies have identified risk factors for survival and complications. Study design: We performed a retrospective, 132-month study that included univariate and multivariate analyses. Results: We studied 204 patients with 298 vessel injuries: 204 were arterial, 94 were venous. Mean age (± SD) was 29 ± 13 years and mean Injury Severity Score (± SD) was 17 ± 8. There were 176 (86{\%}) penetrating injuries and 28 (14{\%}) blunt injuries. Arterial repairs included: reverse saphenous vein graft bypass, 108 (53{\%}); primary repair, 53 (26{\%}); PTFE, 21 (10.2{\%}); ligation, 13 (6.4{\%}); and vein patch, 9 (4.4{\%}). Venous repairs included: ligation, 49 (52{\%}); primary repair, 41 (44{\%}); and bypass, 4 (4{\%}). Fasciotomies included: calf, 56 (27{\%}); thigh, 25 (12{\%}); traumatic amputations, 6 (3{\%}); and delayed amputations, 0. Overall survival rate was 91{\%} (186 of 204), and adjusted survival was 95{\%} (excluding emergency department thoracotomy deaths). There were 1 or more complications in 47 (23{\%}), including wound infection, 31 (15{\%}); venous thrombosis, 6 (3{\%}); bleeding, 5 (2.5{\%}); ARDS, 4 (2{\%}); and arterial thrombosis, 1 (0.5{\%}). Predictors of mortality were age > 45 years, Injury Severity Score > 25, common femoral artery injury, associated venous and abdominal injury, hypotension, hypothermia, and acidosis; coagulopathy in the operating room and the need for PTFE repair also predicted outcomes. Predictors of postoperative complications were intraoperative hypotension, arterial intimal injury, bony fracture, and thoracic injury. Conclusions: Although survival and limb salvage rates are high for femoral vessel injuries, these injuries incur high complication rates. Independent predictors for mortality are: Injury Severity Score > 25, Glasgow Coma Scale 28, presence of coagulopathy in the operating room, presence of two or more vascular signs, and age > 45 years.",
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T2 - Analysis of Factors Predictive of Outcomes

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AU - Petrone, Patrizio

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N2 - Background: Femoral vessel injuries are the most common vascular injuries treated in a Level I trauma center. No studies have identified risk factors for survival and complications. Study design: We performed a retrospective, 132-month study that included univariate and multivariate analyses. Results: We studied 204 patients with 298 vessel injuries: 204 were arterial, 94 were venous. Mean age (± SD) was 29 ± 13 years and mean Injury Severity Score (± SD) was 17 ± 8. There were 176 (86%) penetrating injuries and 28 (14%) blunt injuries. Arterial repairs included: reverse saphenous vein graft bypass, 108 (53%); primary repair, 53 (26%); PTFE, 21 (10.2%); ligation, 13 (6.4%); and vein patch, 9 (4.4%). Venous repairs included: ligation, 49 (52%); primary repair, 41 (44%); and bypass, 4 (4%). Fasciotomies included: calf, 56 (27%); thigh, 25 (12%); traumatic amputations, 6 (3%); and delayed amputations, 0. Overall survival rate was 91% (186 of 204), and adjusted survival was 95% (excluding emergency department thoracotomy deaths). There were 1 or more complications in 47 (23%), including wound infection, 31 (15%); venous thrombosis, 6 (3%); bleeding, 5 (2.5%); ARDS, 4 (2%); and arterial thrombosis, 1 (0.5%). Predictors of mortality were age > 45 years, Injury Severity Score > 25, common femoral artery injury, associated venous and abdominal injury, hypotension, hypothermia, and acidosis; coagulopathy in the operating room and the need for PTFE repair also predicted outcomes. Predictors of postoperative complications were intraoperative hypotension, arterial intimal injury, bony fracture, and thoracic injury. Conclusions: Although survival and limb salvage rates are high for femoral vessel injuries, these injuries incur high complication rates. Independent predictors for mortality are: Injury Severity Score > 25, Glasgow Coma Scale 28, presence of coagulopathy in the operating room, presence of two or more vascular signs, and age > 45 years.

AB - Background: Femoral vessel injuries are the most common vascular injuries treated in a Level I trauma center. No studies have identified risk factors for survival and complications. Study design: We performed a retrospective, 132-month study that included univariate and multivariate analyses. Results: We studied 204 patients with 298 vessel injuries: 204 were arterial, 94 were venous. Mean age (± SD) was 29 ± 13 years and mean Injury Severity Score (± SD) was 17 ± 8. There were 176 (86%) penetrating injuries and 28 (14%) blunt injuries. Arterial repairs included: reverse saphenous vein graft bypass, 108 (53%); primary repair, 53 (26%); PTFE, 21 (10.2%); ligation, 13 (6.4%); and vein patch, 9 (4.4%). Venous repairs included: ligation, 49 (52%); primary repair, 41 (44%); and bypass, 4 (4%). Fasciotomies included: calf, 56 (27%); thigh, 25 (12%); traumatic amputations, 6 (3%); and delayed amputations, 0. Overall survival rate was 91% (186 of 204), and adjusted survival was 95% (excluding emergency department thoracotomy deaths). There were 1 or more complications in 47 (23%), including wound infection, 31 (15%); venous thrombosis, 6 (3%); bleeding, 5 (2.5%); ARDS, 4 (2%); and arterial thrombosis, 1 (0.5%). Predictors of mortality were age > 45 years, Injury Severity Score > 25, common femoral artery injury, associated venous and abdominal injury, hypotension, hypothermia, and acidosis; coagulopathy in the operating room and the need for PTFE repair also predicted outcomes. Predictors of postoperative complications were intraoperative hypotension, arterial intimal injury, bony fracture, and thoracic injury. Conclusions: Although survival and limb salvage rates are high for femoral vessel injuries, these injuries incur high complication rates. Independent predictors for mortality are: Injury Severity Score > 25, Glasgow Coma Scale 28, presence of coagulopathy in the operating room, presence of two or more vascular signs, and age > 45 years.

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