Femoral Vessel Injuries: Analysis of Factors Predictive of Outcomes

Penetrating arterial trauma to the limbs: outcome of a modified protocol

“…It was thus interesting to compare our previous experience outcome on each different anatomical site of injury with the actual results and with the literature. As pointed out, isolated vascular injury may come with an amputation rate as low as 3% [15], but penetrating trauma, increased transport times (longer warm ischemia time) and coagulopathy may push the amputation rate up to 33% and higher [16], as do combined arterio-venous trauma, fractures [17,18], hypotension and torso injuries increase mortality [19]. …”

Lower Extremity Vascular Trauma

“…14 Comparatively, Asensio et al reported femoral vessel injuries to be even more common, accounting for nearly 70% of peripheral vascular injuries. 15 However, in isolated lower extremity trauma, the most commonly injured artery is the popliteal, with the majority of injuries resulting from blunt mechanism. 16 Blunt injuries are more likely to be associated with orthopedic fractures or dislocations and likely to result in longer hospital stays and higher rates of amputation than other lower forms of extremity arterial injury.…”

“…However, experience shows that most injuries in this location are accompanied by hemorrhage and/or ischemia at some point following the event. 15 In some cases, limb-threatening complications may result from overlooking or missing the hard signs of vascular injury because the active bleeding will have stopped or the degree of ischemia will be incomplete. 25 Although most cases of femoral or popliteal trauma with hard signs require prompt operative intervention, contrast arteriography or CTA may be useful in more complex scenarios.…”

Modern Advances in Vascular Trauma

“…66 Studies have estimated the risk of an arterial injury to be as low as 3% with a single soft sign to as high as 25% with multiple findings present. 1,2,62 Invasive arteriography has traditionally been the gold standard when imaging is warranted and data support improved outcome secondary to reduction in time to revascularization when the arteriography is performed in the operating room. 56 Patients who require another emergent operative procedure, are unstable with highrisk associated orthopedic injuries, those with a high pretest probability of arterial injury (for example, multiple soft signs), or those in whom hard signs are present but better localization of the injury is necessary (ie, multiple gunshot wounds to a single extremity) should also go directly to the operating room for intraoperative arteriography.…”

“…74 Fasciotomies should be considered in all severely injured extremities (MESS8), those in whom repair is not complete within 6 hours of injury, those requiring significant resuscitation or transfusion, or those with a high risk of development of compartment syndrome secondary to orthopedic fractures including complex open fractures. 2,56,58,74 In addition to the potential modifiable risk factors discussed earlier, several nonmodifiable risk factors contribute to poor outcome. The presence of an associate venous injury in the same limb, extensive soft tissue loss leading to infection, extensive bony injury requiring complex bony reconstruction, delayed presentation to the hospital, preexisting vascular disease, major nerve injury, and the peripheral artery injury all are major factors.…”