Management of distal femoral and popliteal arterial injuries: an update.
BACKGROUND
The management of combined arterial and musculoskeletal injuries to the lower extremity remains controversial, particularly with regard to the initial order of intervention and the use of intravascular shunting. In this study, we review the contemporary management and outcome of patients treated for acute traumatic distal femoropopliteal arterial injuries.


METHODS
From January 2001 to January 2006, we repaired 57 acute traumatic lower-extremity arterial injuries in a level 1 trauma center. Our approach was to perform surgical revascularization without intraluminal shunting as soon as the arterial injury was recognized. There were 44 men (77%). Mean age was 31 years (range, 5-68). The mechanism of injury was blunt in 42 of 57 (74%) patients. Vascular reconstruction was achieved by using an autogenous saphenous vein graft in 52 of 57 (91%), a vein patch in 3 of 57 (5%), or primarily in 2 of 57 (4%) patients.


RESULTS
The limb-salvage rate was 92% (53/57). Thirty-six patients (63%) had associated orthopedic fixation: 12 of 36 (33%) before and 24 of 36 (67%) after revascularization. Twenty-one of 57 patients (37%) had vascular repair only without orthopedic fixation. Thirty-four patients (60%) required fasciotomy. Four patients had subsequent above-knee amputation: 3 because of wound complications despite successful revascularization and 1 because of failed revascularization. There were no complications related to the arterial repairs that were performed before orthopedic fixation.


CONCLUSIONS
Our study shows that arterial reconstruction for acute traumatic lower-limb injuries results in a good limb-salvage rate. We advocate prompt vascular repair before orthopedic intervention for combined vascular and skeletal injuries of the lower extremity, without using intravascular shunting.
Huynh
Tam T T
TT
Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Faculty Center, Baylor College of Medicine, 1709 Dryden Street, Suite #1500, Houston, TX 77030, USA. thuynh@bcm.edu <thuynh@bcm.edu>
Pham
Mai
M
Griffin
Lance W
LW
Villa
Martin A
MA
Przybyla
J Alan
JA
Torres
Ricardo H
RH
Keyhani
Kourosh
K
Safi
Hazim J
HJ
Moore
Frederick A
FA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D002648:Child; D005205:Fascia; D005260:Female; D005263:Femoral Artery / Q000293:injuries*; D006801:Humans; D007869:Leg Injuries / Q000601:surgery; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply / Q000293:injuries; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D011150:Popliteal Artery / Q000293:injuries*; D012501:Saphenous Vein / Q000637:transplantation; D013997:Time Factors; D014656:Vascular Surgical Procedures