TY - JOUR
T1 - Popliteal artery injuries. Less ischemic time may lead to improved outcomes
AU - Asensio, Juan A.
AU - Dabestani, Parinaz J.
AU - Miljkovic, Stephanie S.
AU - Kotaru, Tharun R.
AU - Kessler, John J.
AU - Kalamchi, Louay D.
AU - Wenzl, Florian A.
AU - Sanford, Arthur P.
AU - Rowe, Vincent L.
N1 - Publisher Copyright:
© 2020
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/11
Y1 - 2020/11
N2 - Background: Popliteal artery injuries are rare. They have high amputation rates. Objectives: To report our experience, identify predictors of outcome; mechanism of injury (MOI), Mangled Extremity Severity Score (MESS) score and length of ischemic time. We hypothesized that ischemic time as close to six hours results in improved outcomes. Methods: Retrospective 132-month study. All popliteal artery injuries. Urban Level I Trauma Center. Outcome Measures: MOI, ISS, MESS, ischemic time, risk factors for amputation, role of popliteal venous injuries, and limb salvage. Statistical analysis: univariate and multivariate. Results: 76 patients – 59 (76.1%) males and 17 (22.4%) females. MOI: penetrating – 54 (71%). MESS for penetrating injuries – 5.8 ± 1.5, blunt injuries – 5.6 ± 1.8. Admission-perfusion restoration (n = 76) – 5.97 hours (358 minutes). Ischemic time was not predictive of outcome (p = 0.79). Ischemic time penetrating (n = 58) 5.9 hours (354 ± 209 minutes), blunt 6.1 hours (371 ± 201 minutes). Popliteal arterial repairs: RSVG 44 (58%), primary repair 21 (26%), PTFE 3 (4%), vein patch 2 (2%), ligation 2 (3%), exsanguinated 4 (6%). No patients underwent stenting. Popliteal Vein: Repair 19 (65%), ligation 10 (35%). Fasciotomies 45 patients (59%). Outcomes: Limb salvage – 90% (68/76). Adjusted limb salvage excluding intraoperative deaths – 94% (68/72). Selected patient characteristics; MOI: penetrating vs. blunt – age (p <0.0005). Amputated vs. non-amputated patients, age (p < 0.05). ISS (p < 0.005) predicted amputation, MESS (p = 0.98) did not. Mean ischemic time (p = 0.79) did not predict amputation. Relative risk of amputation, MOI – blunt (p = 0.26, RR 4.67, 95% CI: 1.11 – 14.1), popliteal artery ligation (p = 0.06, RR 3.965, 95% CI: 1.11 – 14.1) as predictors of outcome. Combined artery and vein injuries (p = 0.25) did not predict amputation. Conclusions: Decreasing ischemic time from arrival to restoration of perfusion may lead to improved outcomes and increased limb salvage. MESS is not predictive for amputation. Blunt MOI is a risk factor for amputation. Maintaining ischemic times as close to six hours as possible may lead to improved outcomes.
AB - Background: Popliteal artery injuries are rare. They have high amputation rates. Objectives: To report our experience, identify predictors of outcome; mechanism of injury (MOI), Mangled Extremity Severity Score (MESS) score and length of ischemic time. We hypothesized that ischemic time as close to six hours results in improved outcomes. Methods: Retrospective 132-month study. All popliteal artery injuries. Urban Level I Trauma Center. Outcome Measures: MOI, ISS, MESS, ischemic time, risk factors for amputation, role of popliteal venous injuries, and limb salvage. Statistical analysis: univariate and multivariate. Results: 76 patients – 59 (76.1%) males and 17 (22.4%) females. MOI: penetrating – 54 (71%). MESS for penetrating injuries – 5.8 ± 1.5, blunt injuries – 5.6 ± 1.8. Admission-perfusion restoration (n = 76) – 5.97 hours (358 minutes). Ischemic time was not predictive of outcome (p = 0.79). Ischemic time penetrating (n = 58) 5.9 hours (354 ± 209 minutes), blunt 6.1 hours (371 ± 201 minutes). Popliteal arterial repairs: RSVG 44 (58%), primary repair 21 (26%), PTFE 3 (4%), vein patch 2 (2%), ligation 2 (3%), exsanguinated 4 (6%). No patients underwent stenting. Popliteal Vein: Repair 19 (65%), ligation 10 (35%). Fasciotomies 45 patients (59%). Outcomes: Limb salvage – 90% (68/76). Adjusted limb salvage excluding intraoperative deaths – 94% (68/72). Selected patient characteristics; MOI: penetrating vs. blunt – age (p <0.0005). Amputated vs. non-amputated patients, age (p < 0.05). ISS (p < 0.005) predicted amputation, MESS (p = 0.98) did not. Mean ischemic time (p = 0.79) did not predict amputation. Relative risk of amputation, MOI – blunt (p = 0.26, RR 4.67, 95% CI: 1.11 – 14.1), popliteal artery ligation (p = 0.06, RR 3.965, 95% CI: 1.11 – 14.1) as predictors of outcome. Combined artery and vein injuries (p = 0.25) did not predict amputation. Conclusions: Decreasing ischemic time from arrival to restoration of perfusion may lead to improved outcomes and increased limb salvage. MESS is not predictive for amputation. Blunt MOI is a risk factor for amputation. Maintaining ischemic times as close to six hours as possible may lead to improved outcomes.
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U2 - 10.1016/j.injury.2020.07.046
DO - 10.1016/j.injury.2020.07.046
M3 - Article
C2 - 32732120
AN - SCOPUS:85088565273
VL - 51
SP - 2524
EP - 2531
JO - Injury
JF - Injury
SN - 0020-1383
IS - 11
ER -