Impact of intraoperative arteriography on limb salvage for traumatic popliteal artery injury.
BACKGROUND
Time to revascularization is speculated to be a major determinant of limb salvage for traumatic popliteal injuries. The purpose of this study was to determine whether location of diagnostic arteriography affected outcome.


METHODS
From 1996 to 2006, patients with popliteal injuries were identified from our trauma database. Additional data were extracted from chart review. Amputation rates for those undergoing arteriography performed in radiology (ARAD) versus the operating room (AOR) were compared.


RESULTS
In 35 patients 36 limbs were treated, with 94% resulting from blunt mechanisms. The mean age was 37 years (11-69 years), 81% were men, and the mean Injury Severity Score was 15. The average mangled extremity severity scores (MESS) was 6 +/- 2. Follow-up was available in 97% patients with a median of 14 months. Overall amputation rate was 16.7% (6 of 36). Extremities with MESS <8 had 93% limb salvage, and MESS > or =8 had 55% limb salvage. ARAD (n = 10) and AOR (n = 15) groups were equivalent with regard to age, mechanism, Injury Severity Score, MESS, time to presentation, associated injuries, and fasciotomy rate. The median time from emergency room arrival to operating room was shorter (125 minutes vs. 214 minutes; p < 0.05) and salvage rate was higher (100% vs. 70%; p = 0.05) in the AOR group compared with the ARAD group.


CONCLUSIONS
For popliteal artery injuries, diagnostic arteriography in the operating room reduces the likelihood of amputation by decreasing time to initiating repair and thereby limiting limb ischemia. Salvage is possible in the most severely injured extremities with rapid transport to the operating room.
Callcut
Rachael A
RA
Department of Surgery, Section of Vascular Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
Acher
Charles W
CW
Hoch
John
J
Tefera
Girma
G
Turnipseed
William
W
Mell
Matthew W
MW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D000792:Angiography / Q000379:methods; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000000981:diagnostic imaging; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011150:Popliteal Artery / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult