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Outcomes of selective tibial artery repair following combat-related extremity injury.
- Source :
-
Journal of vascular surgery [J Vasc Surg] 2010 Jul; Vol. 52 (1), pp. 91-6. Date of Electronic Publication: 2010 May 14. - Publication Year :
- 2010
-
Abstract
- Objective: Selective tibial revascularization refers to the practice of vessel repair vs ligation or observation based on factors observed at the time of injury. Although commonly employed, the effectiveness of this strategy and its impact on sustained limb salvage is unknown. The objective of this study is to define the factors most relevant in selective tibial artery revascularization and to characterize limb salvage following tibial-level vascular injury.<br />Methods: The cohort of active-duty military patients undergoing infrapopliteal artery repair comprises the tibial Bypass group. A similarly injured cohort of patients that did not undergo operative vascular intervention (No Bypass group) was identified. All tibial vessel injuries were documented by angiography. Data were compiled via medical records and patient interview. The primary outcome measure was failure of limb salvage. Multivariate regression was performed to identify factors associated with revascularization and to describe factors associated with amputation.<br />Results: Between March 2003 and September 2008, 135 of 1332 patients with battle-related vascular injuries had documented tibial vessel disruption or occlusion. Of these, 104 were included for analysis. Twenty-one underwent autologous vein bypass at the time of injury (Bypass group), and the remaining 83 patients were managed without revascularization (No Bypass group). Mean follow-up (39 vs 41 months; P = .27), age (25 vs 27 years; P = .66), and mechanism of injury (88% vs 92% penetrating blast; P = .56) were similar, but the No Bypass group had higher Injury Severity Scores (ISS; 16.3 vs 11.7; P < .01). Injury characteristics, including Gustilo III classification (49% vs 43%; P = .81) and nerve injury (55% vs 53%; P = 1.0), were similar. Subjects were more likely to receive tibial bypass with an increasing number of tibial vessel occlusions and documented ischemia on initial exam. However, of the 23 in the No Bypass group with initially unobtainable Doppler signals, 17 (74%) regained pedal flow following resuscitation and limb stabilization. Amputation rates were similar (23% vs 19%; P = .79), but the prevalence of chronic limb pain was lower in the Bypass group (10% vs 30%, respectively; P = .08). Cox regression analysis of amputation-free survival demonstrated an association between mangled extremity severity score >5 (hazard ratio [HR], 2.7; P = .01) and amputation.<br />Conclusions: This report provides outcomes data for wartime tibial vascular injury, which supports a selective approach to tibial artery revascularization. Clinical factors such as ISS and degree of ischemia guide which patients are best suited for tibial vascular repair, while injury-specific characteristics are associated with amputation regardless of revascularization status.<br /> (Published by Mosby, Inc.)
- Subjects :
- Adult
Amputation, Surgical
Humans
Kaplan-Meier Estimate
Limb Salvage
Logistic Models
Proportional Hazards Models
Radiography
Registries
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Tibial Arteries diagnostic imaging
Tibial Arteries injuries
Time Factors
Transplantation, Autologous
Treatment Outcome
Ultrasonography, Doppler
Wounds and Injuries diagnosis
Wounds and Injuries mortality
Young Adult
Extremities blood supply
Military Personnel
Tibial Arteries surgery
Veins transplantation
Warfare
Wounds and Injuries surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6809
- Volume :
- 52
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 20471774
- Full Text :
- https://doi.org/10.1016/j.jvs.2010.02.017