title: Factors Associated with Amputation after Popliteal Vascular Injuries.
abstract: Popliteal artery trauma has the highest rate of limb loss of all peripheral vascular injuries. The objectives of this study were to evaluate outcomes after popliteal vascular injury and to identify predictors of amputation.
  
  
  
  Retrospective data over a 14-year period were collected for patients with popliteal artery with or without vein injuries. Patient demographics, mechanism of injury, Injury Severity Score (ISS), Mangled Extremity Severity Score (MESS), and physiologic parameters were extracted. Time to operative intervention, operative time, type of vascular repair, need for concomitant orthopedic procedures, and outcomes including amputation rate, and in-hospital mortality were recorded.
  
  
  
  Fifty-one patients were found to have popliteal artery injuries, with a median age of 25 (range 10-70 years). The median ISS was 9, and the mean extremity Abbreviated Injury Severity score was 3. The mechanism of injury was blunt for 43% and penetrating for 57%. Fasciotomies were performed in 74% of patients and 64% of patients underwent combined orthopedic and vascular procedures. Overall, 66% of these patients had their vascular procedure performed first. Ten patients required amputation: 1 immediate and 9 after attempted limb salvage (20%). We found that those patients requiring amputation had a higher incidence of blunt trauma (80% vs. 35%, P = 0.014) and higher MESS score (7.1 vs. 4.7, P = 0.02). There was no difference in the incidence of amputation for those who underwent orthopedic fixation before vascular repair (P = 0.68).
  
  
  
  Popliteal vascular injuries continue to be associated with a high risk of amputation. Those patients undergoing attempted limb salvage should be revascularized expediently, but selected patients may undergo orthopedic stabilization before vascular repair without increased risk of limb loss.
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Keeley
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Koopmann
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Huan
authors.initials: H
authors.lastname: Yan
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Christian
authors.initials: C
authors.lastname: DeVirgilio
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Brant
authors.initials: B
authors.lastname: Putnam
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: David
authors.initials: D
authors.lastname: Plurad
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA. Electronic address: dekim@dhs.lacounty.gov.
authors.forename: Dennis
authors.initials: D
authors.lastname: Y Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects / Q000401:mortality; D002648:Child; D000071938:Fasciotomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019637:Orthopedic Procedures; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D055815:Young Adult