Femoral vessel injuries: analysis of factors predictive of outcomes.
BACKGROUND
Femoral vessel injuries are the most common vascular injuries treated in a Level I trauma center. No studies have identified risk factors for survival and complications.


METHODS
We performed a retrospective, 132-month study that included univariate and multivariate analyses.


RESULTS
We studied 204 patients with 298 vessel injuries: 204 were arterial, 94 were venous. Mean age (+/- SD) was 29+/-13 years and mean Injury Severity Score (+/- SD) was 17+/-8. There were 176 (86%) penetrating injuries and 28 (14%) blunt injuries. Arterial repairs included: reverse saphenous vein graft bypass, 108 (53%); primary repair, 53 (26%); PTFE, 21 (10.2%); ligation, 13 (6.4%); and vein patch, 9 (4.4%). Venous repairs included: ligation, 49 (52%); primary repair, 41 (44%); and bypass, 4 (4%). Fasciotomies included: calf, 56 (27%); thigh, 25 (12%); traumatic amputations, 6 (3%); and delayed amputations, 0. Overall survival rate was 91% (186 of 204), and adjusted survival was 95% (excluding emergency department thoracotomy deaths). There were 1 or more complications in 47 (23%), including wound infection, 31 (15%); venous thrombosis, 6 (3%); bleeding, 5 (2.5%); ARDS, 4 (2%); and arterial thrombosis, 1 (0.5%). Predictors of mortality were age>45 years, Injury Severity Score>25, common femoral artery injury, associated venous and abdominal injury, hypotension, hypothermia, and acidosis; coagulopathy in the operating room and the need for PTFE repair also predicted outcomes. Predictors of postoperative complications were intraoperative hypotension, arterial intimal injury, bony fracture, and thoracic injury.


CONCLUSIONS
Although survival and limb salvage rates are high for femoral vessel injuries, these injuries incur high complication rates. Independent predictors for mortality are: Injury Severity Score > 25, Glasgow Coma Scale 28, presence of coagulopathy in the operating room, presence of two or more vascular signs, and age > 45 years.
Asensio
Juan A
JA
Division of Trauma and Critical Care, Department of Surgery, Los Angeles County and the University of Southern California Medical Center, Los Angeles, CA, USA.
Kuncir
Eric J
EJ
García-Núñez
Luis M
LM
Petrone
Patrizio
P
D000328:Adult; D000671:Amputation, Surgical; D005260:Female; D005263:Femoral Artery / Q000293:injuries* / Q000601:surgery*; D005268:Femoral Vein / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000150:complications / Q000401:mortality / Q000601:surgery*