title: Observation may be an inadequate approach for injured extremities with single tibial vessel run-off.
abstract: BACKGROUND
  Trauma patients with sudden loss of distal perfusion due to tibial injuries are frequently not offered vascular interventions if a single vessel retains patency. We hypothesized that sudden loss of either all or some tibial vasculature would result in increased non-operative failure and higher amputation rates.
  
  
  METHODS
  In this retrospective observational study, all traumatically injured patients from 2009 to 2012 with CT-angiogram-confirmed anterior tibial, posterior tibial, or peroneal artery injuries were included.
  
  
  RESULTS
  From 2009 to 2012, 437 patients were admitted with arterial extremity injury of which 234 (53%) were lower extremity. From this group, 84 (36%) patients were identified with CT-angiogram-confirmed limited or no flow in the tibial arteries. A total of 44% (4/9) with 0 or 1 tibial vessel failed observation while only 8% (2/27) failed if they had 2 or 3 patent vessels (p < 0.05). Amputation rate was inversely related the number of open tibial vessels. There were 2.7 open tibial vessels in the limb salvage group compared to 1.1 in the amputation group (p < 0.05).
  
  
  CONCLUSIONS
  Patients who failed an initial trial of observation were significantly more likely to have 0 or 1 tibial vessels patent. The number of open tibial vessels is significantly associated with limb salvage.
authors.affiliation: Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas-Houston, TX, USA Department of Surgery, Medical College of Wisconsin, WI, USA andua@mcw.edu.
authors.forename: Anahita
authors.initials: A
authors.lastname: Dua
authors.affiliation: Department Vascular Surgery, Southern Illinois University, IL, USA.
authors.forename: Sapan S
authors.initials: SS
authors.lastname: Desai
authors.affiliation: Department of Radiology, University of Texas-Houston, TX, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Johnston
authors.affiliation: Department of Radiology, University of Texas-Houston, TX, USA.
authors.forename: Naga R
authors.initials: NR
authors.lastname: Chinapuvvula
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas-Houston, TX, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: DuBose
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas-Houston, TX, USA.
authors.forename: Kristofer
authors.initials: K
authors.lastname: Charlton-Ouw
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas-Houston, TX, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Azizzadeh
authors.affiliation: Department of Orthopedic Surgery, University of Houston-Texas, TX, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Burgess
authors.affiliation: Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas-Houston, TX, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.affiliation: Department of Surgery, Denver Health Medical Center and the University of Colorado School of Medicine, CO, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Fox
authors.affiliation: Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas-Houston, TX, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D013977:Tibia / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D057832:Watchful Waiting; D055815:Young Adult
keywords: Tibial vessels; amputation; revascularization; trauma