title: Limb amputation among patients with surgically treated popliteal arterial injury: analysis of 15 years of experience in an urban trauma center in Cali, Colombia.
abstract: BACKGROUND
  Popliteal arterial injuries carry a high risk of amputation. The currently available literature from both civilian and military experiences is characterized by a wide variation of recommendations for surgical management. We questioned how these recommendations have been applied in our practice. Therefore, we aimed to identify predictors of amputation after popliteal arterial injury.
  
  
  METHODS
  We conducted an observational study of 175 patients with popliteal arterial injuries who underwent surgical treatment from 1992 to 2006 at a level I trauma center in Cali, Colombia. Information on demographic characteristics, clinical information, and surgical management was collected from clinical records. The outcome measure was amputation within 30 days following the first surgical intervention.
  
  
  RESULTS
  The amputation rate was 17.1%. A multivariable logistic regression model indicates that blunt mechanism (odds ratio [OR] 4.79, 95% confidence interval [CI] 1.49-15.42), signs of ischemia (OR 5.29, 95% CI 1.48-18.91), ligation of the popliteal vein of the compromised limb during surgical exploration (OR 3.83, 95% CI 1.20-12.18), and the development of arterial thrombosis (OR 56.51, 95% CI 12.36-258) were found to be independent predictors of amputation. Fractures, popliteal venous injuries, prolonged time between injury and surgery, fasciotomies, and graft arterial repair were not statistically significant predictors of amputation.
  
  
  CONCLUSIONS
  Emphasis on the early assessment and prompt identification of signs of ischemia after popliteal arterial injury continue to be the most important factor for reducing the risk of amputation, especially in blunt trauma. Vascular trauma teams must emphasize the need for the specialized management of popliteal veins. Clinical research is needed in order to identify means of decreasing arterial thrombosis after popliteal repair.
authors.affiliation: Department of Surgery, Universidad del Valle, Cali, Colombia.|CISALVA Institute, Universidad del Valle, Cali, Colombia.|Department of Surgery, Fundación Valle del Lili, Cali, Colombia.
authors.forename: A F
authors.initials: AF
authors.lastname: García
authors.affiliation: CISALVA Institute, Universidad del Valle, Cali, Colombia. ais6@pitt.edu.|Department of Surgery, University of Pittsburgh, 200 Lothrop Street, F1263 PRESB, Pittsburgh, PA, 15213, USA. ais6@pitt.edu.
authors.forename: Á I
authors.initials: ÁI
authors.lastname: Sánchez
authors.affiliation: Department of Surgery, Hospital Universitario del Valle, Cali, Colombia.
authors.forename: M
authors.initials: M
authors.lastname: Millán
authors.affiliation: Department of Surgery, Fundación Valle del Lili, Cali, Colombia.
authors.forename: J P
authors.initials: JP
authors.lastname: Carbonell
authors.affiliation: Department of Surgery, Universidad del Valle, Cali, Colombia.|Department of Surgery, Centro Médico Imbanaco, Cali, Colombia.
authors.forename: R
authors.initials: R
authors.lastname: Ferrada
authors.affiliation: CISALVA Institute, Universidad del Valle, Cali, Colombia.
authors.forename: M I
authors.initials: MI
authors.lastname: Gutíerrez
authors.affiliation: Department of Surgery, University of Pittsburgh, 200 Lothrop Street, F1263 PRESB, Pittsburgh, PA, 15213, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Peitzman
authors.affiliation: Department of Surgery, University of Pittsburgh, 200 Lothrop Street, F1263 PRESB, Pittsburgh, PA, 15213, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Puyana
keywords: Amputation; Lower limb injuries; Penetrating trauma; Popliteal artery; Vascular surgery
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