Contemporary Outcomes of Civilian Lower Extremity Arterial Trauma

Abstract

and the prevalence of PAD in individuals who underwent vascular screening and BMD measurements.Methods: Patients underwent arterial Doppler studies; PAD was noted with an ankle-brachial index of #0.9. T scores were calculated using bone densitometry of the calcaneus. Normal was a T score of À1.0 or higher, osteopenia with a T score between À1.0 and À2.5, and osteoporosis with a T score of À2.5 or lower. Subject demographics, comorbidities, and history were self-reported. Univariate and multivariate statistics were used.Results: Of 766,172 men, osteopenia was noted in 23.4% and osteoporosis in 1.1%. Men with abnormal T scores did not have a different risk factor profile than normal men but had a higher rate of prior myocardial infarction (MI) and were older. The prevalence of PAD was higher in men with osteopenia (4.5%) and osteoporosis (10.9%) than in men with normal T scores (3%; P < .0001). Logistic regression controlling for age and risk factors revealed osteopenia (odds ratio [OR], 1.3) and osteoporosis (OR, 2.3) were independent risk factors for PAD in men. Of 1,256,909 women, osteopenia was noted in 30.3% and osteoporosis in 2.4%. Women with abnormal T scores were older and had a higher rate of prior MI but did not have a different risk factor profile than women with normal T scores. The prevalence of PAD was higher in women with osteopenia (4.8%) and osteoporosis (11.8%) than in normal women (3.3%; P < .001). Logistic regression again revealed osteopenia (OR, 1.15) and osteoporosis (OR, 1.8) were both independent risk factors for PAD in women. In a further examination of women stratifying by age, osteoporotic women had a significantly increased prevalence of PAD in all age groups (Fig).Conclusions: The current study reports a strong association of BMD analysis with the prevalence of PAD, which persists even when controlling for age and risk factors. The presence of osteoporosis should make clinicians aware of the possibility of occult PAD in appropriate patients.Objectives: Hospital readmissions after surgical operations are considered as serious complications and affect health care associated costs. The Centers for Medicare and Medicaid services (CMS) strongly encourages identification and ramification of factors associated with hospital readmissions after operations. Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease (PAD). The purpose of this study was to retrospectively review the factors associated with hospital readmission after lower extremity bypass surgery.Methods: The 2013 lower extremity revascularization-targeted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and generalized 2013 general and vascular surgery ACS-NSQIP Participant Use File were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing lower extremity bypass surgery were assessed. Multivariate logistic regression analysis was used to det...

Blunt Traumatic Injury to the Superficial Femoral Artery in a Morbidly Obese Female: Case Report Using Endovascular Covered Stent Repair

“…The incidence of lower extremity arterial injury has been reported to occur in approximately 0.3% of all civilian trauma admissions. 2 Arterial injuries resulting from blunt trauma are even more rare and require a high-impact mechanism. 4 A study of 651 infra-inguinal arterial injuries identified from the NTDB found that 34% (n = 220) of injuries resulted from blunt trauma.…”

“…1 Femoral vessel injuries in particular account for the majority of lower extremity vascular injuries (LEVI), most commonly the consequence of penetrating mechanisms. 1,2 Blunt arterial injuries develop from the stretch or shearing force but can also culminate from a contusion or crushed extremity. Historically, LEVIs had substandard survivability; however, surgical management has evolved leading to lower mortality rates.…”

Popliteal artery occlusion concomitant with a tibial plateau fracture and posterior cruciate ligament avulsion fracture

“…1 The prevalence of arterial injury after blunt lower extremity fractures has been reported as 1.04%. 2,3 Popliteal artery injury associated with a tibial plateau fracture with PCL avulsion fracture is a rare condition. Therefore, close monitoring of this condition is required.…”

Factores pronósticos para pérdida de extremidad con trauma arterial periférico en un hospital de Colombia

“…Se compromete en mayor medida las extremidades inferiores 31-36%, seguido de las extremidades superiores 18,4-31%, vasos abdominales y pélvicos 15,6-21%, cuello 10-24,8% y tórax 10-13,8% 3,6,7 . La severidad y el mecanismo de las lesiones han sido descritos en relación a la necesidad de manejo quirúrgico que varía entre 2-60% de todas las lesiones vasculares 1,2 . Dentro de los procedimientos requeridos en la reparación de estas lesiones se encuentran las ligaduras vasculares, reparos primarios, bypass o la embolización selectiva; tales procedimientos presentan complicaciones postquirúrgicas como la trombosis o estenosis del reparo en un 3%, infección del sitio operatorio, reintervención por alguna causa relacionada al procedimiento inicial de 7,7% y las amputaciones 3,3-29% 8,9 .…”

“…Dentro de los procedimientos requeridos en la reparación de estas lesiones se encuentran las ligaduras vasculares, reparos primarios, bypass o la embolización selectiva; tales procedimientos presentan complicaciones postquirúrgicas como la trombosis o estenosis del reparo en un 3%, infección del sitio operatorio, reintervención por alguna causa relacionada al procedimiento inicial de 7,7% y las amputaciones 3,3-29% 8,9 . La mortalidad relacionada a estas lesiones se ha descrito alrededor del 2-22,9% 6,7,9 estos valores varían dependiendo de las variables como la energía del mecanismo de la lesión, tiempo de evolución a la atención, el sitio de la lesión, lesiones asociadas, tipo de reparo y características operativas de la cirugía inicial, entre otras 2,11 .…”