title: Limb loss following lower extremity arterial trauma: what can be done proactively?
abstract: We performed a retrospective review of patients admitted to two Level I trauma centres over a 15-year period with arterial injuries (excluding primary amputations). Preoperative factors analysed included mechanism of injury, site and type of arterial and venous injury and repair, time to operating room, initial blood pressure, evidence of ipsilateral limb fracture and/or extensive tissue damage, status of preoperative pulses and angiographic data. One hundred and fifty-one arterial injuries were treated (80 penetrating). Overall mortality was 10 (6.6%) and limb loss 16 (10.6%). Only two factors that might possibly be modified by specific interventions were noted. The incidence of limb loss was higher in patients who developed compartment syndrome (41% versus 7% without, P=0.003) and in those who did not receive intra- or immediately postoperative anticoagulation (15% without versus 3% with, P=0.02). Unfortunately, no factor was found that reliably predicted the risk of compartment syndrome. In addition, patients who did not receive peri-operative anticoagulation were more severely injured than those that did were. Despite this, there were no bleeding complications associated with anticoagulation. These findings suggest that the primary interventions that may improve limb salvage include liberal use of fasciotomy (recognising that any patient may require this) as well as early use of anticoagulation.
authors.affiliation: Department of Surgery, Harborview Medical Centre, 352 Ninth Avenue, Box 359796, Seattle, WA 98104, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Guerrero
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gibson
authors.forename: Kurt A
authors.initials: KA
authors.lastname: Kralovich
authors.forename: Iraklis
authors.initials: I
authors.lastname: Pipinos
authors.forename: Petros
authors.initials: P
authors.lastname: Agnostopolous
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Carter
authors.forename: Eileen
authors.initials: E
authors.lastname: Bulger
authors.forename: Mark
authors.initials: M
authors.lastname: Meissner
authors.forename: Riyad
authors.initials: R
authors.lastname: Karmy-Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D000925:Anticoagulants / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation; D003161:Compartment Syndromes / Q000209:etiology / Q000601:surgery; D005260:Female; D005263:Femoral Artery / Q000293:injuries; D006801:Humans; D007083:Iliac Artery / Q000293:injuries; D007866:Leg / Q000098:blood supply*; D007869:Leg Injuries / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D011150:Popliteal Artery / Q000293:injuries; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000925:Anticoagulants