title: The management of lower extremity multilevel arterial injuries: a 10-year experience.
abstract: BACKGROUND
  Limb amputation due to lower extremity arterial injury is not uncommon and multilevel arterial injury is even more limb-threatening and easily missed with potentially devastating consequences. There is limited information on multilevel arterial injuries.
  
  
  OBJECTIVE
  We undertook a review of our experience to gain insight on multilevel arterial injury patterns associated with lower extremity trauma and to analyze the results of management of such injuries with a special focus on the influence of initial diagnosis on limb salvage.
  
  
  METHODS
  Between August 2002 and September 2012, 38 patients with lower extremity multilevel arterial injuries were reviewed, retrospectively. The injury patterns and amputation rates associated with initial diagnosis or misdiagnosis were analyzed.
  
  
  RESULTS
  According to their injury levels, three multilevel arterial injury patterns were seen in this series: arterial injuries with the involvement of femoral artery and popliteal artery (pattern A), femoral artery and anterior or (and) posterior artery (pattern B), and popliteal artery and anterior or (and) posterior artery (pattern C). The general missed diagnosis rate was 31.6%. Pattern B had a much higher missed diagnosis rate than the other two patterns. The missed diagnosis rate was significantly correlated with the amputation rates (Odds Ratio =10.7, 95% CI: 2.04-56.61). The definite diagnosis rate was only 14.8% using duplex ultrasonography examination.
  
  
  CONCLUSIONS
  Diagnosis of pattern B injury is more prone to be missed. DUS has low specificity in the detection of multilevel arterial injuries. Aggressive intraoperative exploration is considered to be valuable in the definitive diagnosis of highly suspected cases when other diagnostic tools are unavailable.
authors: Department of Orthopaedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors: Hede
authors: H
authors: Yan
authors: Department of Orthopaedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors: Bin
authors: B
authors: Zhao
authors: Department of Plastic and Hand Surgery, Duke Raleigh Hospital, Raleigh, North Carolina, United States of America.
authors: John
authors: J
authors: Kolkin
authors: Department of Orthopaedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors: Zhijie
authors: Z
authors: Li
authors: Department of Orthopaedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors: Xinglong
authors: X
authors: Chen
authors: Department of Orthopaedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors: Tinggang
authors: T
authors: Chu
authors: Department of Orthopaedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors: Weiyang
authors: W
authors: Gao
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D003710:Demography; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D014463:Ultrasonography; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000628:therapy*