Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma

Perkins, Zane; Yet, Barbaros; Glasgow, Simon; Cole, Elaine; Marsh, William; Brohi, Karim; Rasmussen, Todd E.; Tai, Nigel

doi:10.1002/bjs.9689

Cited by 92 publications

(65 citation statements)

References 87 publications

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“…Amputation rates have dramatically improved since Debakey and Simeone 7 published a large series of popliteal vascular injuries from World War II with a high rate of amputation of 73% after primary arterial ligation. Outcomes of LEAI in the global civilian population are more difficult to quantify due to the low rate of injuries in the general population: despite the large number of patients in some studies 1,8 , results have been difficult to apply to the knowledge of LEAI in the United States as the injury characteristics of many study populations differ substantially in mechanism and injury location with amputation rates ranging from 2 to 33%.…”

Section: Discussionmentioning

confidence: 99%

“…Few retrospective studies comprising few cases from US trauma centers exist secondary to the low rate of LEAI among urban civilian centers, and may reflect older management paradigms for both trauma and vascular therapy 1,2 . Several epidemiologic studies have reviewed the data available from the National Trauma Data Bank (NTDB) 3–5 , but this data is not specific to arterial injury and is limited by selection due to the voluntary nature of the database.…”

Section: Introductionmentioning

confidence: 99%

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Contemporary outcomes of civilian lower extremity arterial trauma

Liang

Alarcon

Jeyabalan

et al. 2016

Journal of Vascular Surgery

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Objectives Lower extremity arterial injury may result in limb loss following blunt or penetrating trauma. The purpose of this study is to examine outcomes of civilian lower extremity arterial trauma and predictors of delayed amputation (DA). Methods The records of patients presenting to a major level I trauma center from 2004-2014 with infrainguinal arterial injury were identified from a prospective institutional trauma registry and outcomes were reviewed. Standard statistical methods were used for data analysis. Results 149 patients were identified (mean age 33±14, 86% male); 46% presented with blunt trauma. 19(13%) had common femoral (CFA), 26(17%) superficial femoral (SFA), 50(33%) popliteal, and 54(36%) tibial injury. Seven patients underwent primary amputation; of the remainder, 21(15%) had ligation, 85(59%) revascularization (80% bypass grafting, 20% primary repair) and the rest observation. 24(17%) eventually required DA; 20(83%) were due to irreversible ischemia or extensive musculoskeletal damage, despite having adequate perfusion. DA rates were 26% for popliteal, 20% for tibial, and 4.4% for CFA/SFA injury. The DA group had significantly more (p<0.05) blunt trauma (79 v. 30%), popliteal injury (46 v. 27%), compound fracture/dislocation (75 v. 33%), bypass graft (63 v. 43%), fasciotomy (75 v. 43%), and higher MESS score (6.1±1.8 v. 4.3±1.6). Predictors of DA included younger age, higher injury severity score, popliteal or multiple tibial injury, blunt trauma, and pulseless exam on presentation. Conclusions Individualized decision making based on age, mechanism, pulseless presentation, extent of musculoskeletal trauma and location of injury should guide intensity of revascularization strategies after extremity arterial trauma. While patients presenting with vascular trauma in the setting of multiple negative prognostic factors should not be denied revascularization, expectations for limb salvage in both the short and long-term periods should be carefully outlined.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Contemporary outcomes of civilian lower extremity arterial trauma

Liang

Alarcon

Jeyabalan

et al. 2016

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

“…The literature on civilian arterial traumatic injuries may not reflect contemporary vascular open and endovascular management, as well advances in medical and anesthetic care. Few retrospective studies comprising few cases from US trauma centers exist secondary to the low rate of LEAI among urban civilian centers, and may reflect older management paradigms for both trauma and vascular therapy 1,2 . Several epidemiologic studies have reviewed the data available from the National Trauma Data Bank (NTDB) [3][4][5] , but this data is not specific to arterial injury and is limited by selection due to the voluntary nature of the database.…”

Section: Introductionmentioning

confidence: 99%

Contemporary Outcomes of Civilian Lower Extremity Arterial Trauma

Liang

Alarcon

Jeyabalan

et al. 2015

Journal of Vascular Surgery

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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...

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“…Victims of vascular trauma may present death risk or limb amputation. Clinical presentation, especially in massive bleeds, can be challenging for the surgeon 2,5,7,8 . Definitive treatment depends on several factors: the injured vessel, the general state of the patient, and the availability of resources, among others 5,7 .…”

Section: Introductionmentioning

confidence: 99%

Trauma vascular na Amazônia: atualizando o desafio.

Góes

Neto

Abib

et al. 2018

Rev. Col. Bras. Cir.

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RESUMO Objetivo: avaliar dados epidemiológicos dos pacientes operados por trauma vascular em hospital de referência para traumatismos vasculares do Estado do Pará, determinar as variáveis que aumentam o risco de óbito e fazer uma análise comparativa com os resultados previamente publicados pela mesma instituição. Métodos: estudo retrospectivo analítico realizado através da coleta de dados de pacientes operados por lesões vasculares, entre março de 2013 e março de 2017. Foram analisados dados demográficos e epidemiológicos, como o mecanismo e topografia da lesão, distância entre o local do trauma e o hospital, tipo de tratamento e complicações. Foi feito ainda o estudo de uma matriz de correlação com regressão logística entre as variáveis e a ocorrência de óbito. Resultados: foram estudados 288 pacientes, com 430 lesões; 92,7% era do sexo masculino, 49,7% entre 25 e 49 anos de idade; 47,2% das lesões foi ocasionada por projéteis de arma de fogo; 47,2% das lesões situava-se nos membros superiores, 42,7% nos membros inferiores, 8% em região cervical, 3,1% torácicas e 0,7% abdominais; 52,8% dos pacientes teve hospitalização por sete dias ou menos. Amputação foi necessária em 6,9% e a mortalidade foi 7,93%. Conclusão: distâncias superiores a 200km foram associadas à internação prolongada e maior probabilidade de amputação de membros. Foi encontrada correlação significativa entre a ocorrência de óbito e o fato de haver lesão arterial, lesão vascular na topografia cervical e lesão vascular na topografia torácica.

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Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma

Abstract: A significant proportion of patients who undergo lower extremity vascular trauma repair will require secondary amputation. This meta-analysis describes significant prognostic factors needed to inform surgical judgement, risk assessment and patient counselling.

Cited by 92 publications

References 87 publications

Contemporary outcomes of civilian lower extremity arterial trauma

Contemporary outcomes of civilian lower extremity arterial trauma

Contemporary Outcomes of Civilian Lower Extremity Arterial Trauma

Trauma vascular na Amazônia: atualizando o desafio.

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