The Analysis Of The Risk Factors Associated With Limb Loss After Lower Extremity Arterial Injury

Objective: The purpose of this study was to review the management of lower extremity arterial injuries to identify the risk factors associated with limb loss during a 5-year period.Methods: The data with lower extremity arterial injuries from 1 January 2010 to 31 December 2014 were collected through Medical Record System and Outpatient Registration System,and analyzed.Femoral artery,deep femoral arteries,popliteal artery,posterior tibial artery,anterior tibial artery and peroneal artery were reviewed in this study.Demographics,mechanism of injury,type of injury,associated lower extremity injuries,concomitant injuries,Injury Severity Score,surgical procedures and interventions,length of stay,adverse outcomes(death,amputation)during initial hospitalization were collected.Data of all patients was screened in chronological order and fill in the specially designed investigation form.Review the information of all patients to eliminate the reviewing patients.Multivariate logistic regression was applied to evaluate the risk factors of associated with limb loss after lower extremity arterial injury.Results: During a 5-year period,379 patients with 431 lower extremity arterial injuries were admitted to the hospital.Involved arterial distribution was as follows: 87 femoral arteries,9 deep femoral arteries,127 popliteal arteries,89 posterior tibial arteries,123 anterior tibial arteries and 4 peroneal arteries.The types of arterial injuries were as follows: 82 type A cases(89 artery injuries),20 type B cases(20 artery injuries),277 type C cases(322 artery injuries).Arterial injuries were categorized into 56 penetrating(14.8%)and 323 blunt mechanisms(85.2%).Among the patients,314(82.8%)were male and 65(17.2%)were female with a mean age of 37.7 years(ranging from 2 to 77 years).94 patients were performed amputation procedures with a total amputation rate of 24.8%.The causes of death were multiple injuries in one and postoperative multiorgan failure in two,giving an overall mortality rate of 0.8%.as primary procedures in 3 patients(4.6%).The injuries receiving vascular management underwent surgical intervention,with procedure distribution as follows: 215 primary repair(56.7%);124 vein graft bypass(32.7%);20 ligation(5.3%);20 the other therapeutic method(5.3%).Fasciotomy was performed in 11.3% of cases.According to the univariate analysis,site of injury(χ~2=50.479,P<0.001),injury severity(χ~2=27.247,P<0.001),mechanism of injury(χ~2=15.880,P<0.001),traumatic shock(χ~2=4.986,P=0.026),degloving injury(χ~2=45.005,P<0.001),type of fracture(χ~2=95.781,P<0.001),time interval from injury(χ~2=16.395,P<0.001),wound pollution levels(χ~2=26.049,P<0.001),surgical procedures(χ~2=21.849,P<0.001),intraoperative blood loss(χ~2=16.805,P<0.001),vascular graft length(χ~2=61.721,P<0.001),fasciotomy(χ~2=4.514,P=0.034)were risk factors.A multivariate logistic regression model was created to identify factors independently associated with limb amputation.Adjusting for age,gender,mechanism,independent predictors of amputation in logistic regression analysis included the level of the knee joint injury(popliteal artery)(odds ratio [OR]=4.540;95% confidence interval [CI]: 1.583-13.022),multiple arterial injuries(OR=4.713;95% CI: 1.464-15.171),type C,complete disruption(OR=8.748;95% CI: 3.052-25.074),prolonged ischemia more than 13 hours(OR=11.597;95% CI: 3.414-39.397),complex and multiple extremity fractures(OR=9.099;95% CI: 2.824-29.319),degloving injury(OR=4.306;95% CI: 1.931-9.603),vascular graft length more than 11cm(OR=7.994;95% CI: 1.776-35.991).Conclusions: A multivariate logistic regression identified the the level of the knee joint injury(popliteal artery),multiple arterial injuries,type C,complete disruption,prolonged ischemia more than 13 hours,complex and multiple extremity fractures,degloving injury,vascular graft length more than 11 cm as independent predictors of amputation.After lower extremity trauma,we suggest that patients with popliteal artery injury or multiple arterial injuries to carry on the effective measures to reduce limb ischemia time and the high-risk of compartment syndrome patients should require a fasciotomy to reduce the amputation rate.