Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss.
OBJECTIVE
We sought to analyze the results of lower limb arterial injury (LLAI) management in a busy metropolitan vascular unit and to identify risk factors associated with limb loss.


METHODS
Between 1987 and 1997, prospectively collected data on 550 patients with 641 lower limb arterial injuries were analyzed.


RESULTS
The mechanism of LLAI was gunshot wounds in 46.1%, blunt in 19%, stabbing in 11.8%, and shotgun in 9.1%. The most frequently injured vessel was the superficial femoral artery (37.2%), followed by the popliteal (30.7%), crural (11%), common femoral (8.7%), and deep femoral (5.3%) arteries. In 3.4% of cases, there was a combined injury on either side of the knee (ipsilaterally). Associated injuries included bony injury in 35.1% of cases, nerve injury in 7.6%, and remote affecting the head, chest, or abdomen in 3.6%. Surgery was carried out on 96.2% of cases with a limb salvage rate of 83.8% and a survival of 98.5%. In spite of a rising trend in LLAI, our total and delayed amputation rates remained stable. On stepwise logistic regression analysis, significant (P <.01) independent risk factors for amputation were occluded graft (odds ratio [OR] 16.7), combined above- and below-knee injury (OR 4.4), tense compartment (OR 4.2), arterial transsection (OR 2.8), and associated compound fracture (OR 2.7).


CONCLUSIONS
LLAI carries a high amputation rate. Stab injuries are the least likely to lead to amputations, whereas high-velocity firearm injuries are the most likely to do so. The most significant independent risk factor for limb loss was failed revascularization.
Hafez
H M
HM
Regional Vascular Unit, St Mary's Hospital, London, United Kingdom. hmhafez@aol.com
Woolgar
J
J
Robbs
J V
JV
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D000792:Angiography; D001158:Arteries / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005263:Femoral Artery / Q000293:injuries / Q000601:surgery; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011150:Popliteal Artery / Q000293:injuries / Q000601:surgery; D011336:Probability; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000601:surgery; D014951:Wounds, Stab / Q000000981:diagnostic imaging / Q000601:surgery