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Popliteal artery injuries. Less ischemic time may lead to improved outcomes.
- Source :
-
Injury . Nov2020, Vol. 51 Issue 11, p2524-2531. 8p. - Publication Year :
- 2020
-
Abstract
- <bold>Background: </bold>Popliteal artery injuries are rare. They have high amputation rates.<bold>Objectives: </bold>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.<bold>Methods: </bold>Retrospective 132-month study. All popliteal artery injuries. Urban Level I Trauma Center.<bold>Outcome Measures: </bold>MOI, ISS, MESS, ischemic time, risk factors for amputation, role of popliteal venous injuries, and limb salvage.<bold>Statistical Analysis: </bold>univariate and multivariate.<bold>Results: </bold>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%).<bold>Outcomes: </bold>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.<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00201383
- Volume :
- 51
- Issue :
- 11
- Database :
- Academic Search Index
- Journal :
- Injury
- Publication Type :
- Academic Journal
- Accession number :
- 146683508
- Full Text :
- https://doi.org/10.1016/j.injury.2020.07.046