Popliteal artery injuries. Less ischemic time may lead to improved outcomes

Juan A. Asensio, Parinaz J. Dabestani, Stephanie S. Miljkovic, Tharun R. Kotaru, John J. Kessler, Louay D. Kalamchi, Florian A. Wenzl, Arthur P. Sanford, Vincent L. Rowe

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article number8946
JournalInjury
DOIs
StateAccepted/In press - 2020

All Science Journal Classification (ASJC) codes

  • Emergency Medicine
  • Orthopedics and Sports Medicine

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    Asensio, J. A., Dabestani, P. J., Miljkovic, S. S., Kotaru, T. R., Kessler, J. J., Kalamchi, L. D., Wenzl, F. A., Sanford, A. P., & Rowe, V. L. (Accepted/In press). Popliteal artery injuries. Less ischemic time may lead to improved outcomes. Injury, [8946]. https://doi.org/10.1016/j.injury.2020.07.046