Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202200202
Jornal Vascular Brasileiro
Original Article

Prognostic factors in treatment of traumatic femoropopliteal arterial injuries at a Brazilian trauma center

Fatores prognósticos no tratamento de lesão traumática arterial femoropoplítea em um centro de trauma brasileiro

Gustavo Henrique Dumont Kleinsorge; Pedro Gustavo Rezende Teixeira; Claudia Caroline Barbosa Pfannes; Rodrigo Di Vita do Lago; Simone de Campos Vieira Abib

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Abstract

Abstract: Background: Despite significant improvements in outcomes, traumatic arterial limb injuries remain a significant cause of limb loss and mortality.

Objectives: This study sought to identify predictors of mortality and major amputation in patients undergoing revascularization after femoropopliteal arterial trauma.

Methods: This was a retrospective review of a trauma registry from an urban trauma center in Brazil. All patients admitted to our hospital with a femoropopliteal arterial injury from November 2012 to December 2017 who underwent vascular reconstruction were included. Univariate analyses and logistic regression analyses were conducted to identify factors independently associated with the primary outcome of amputation and the secondary outcome of mortality.

Results: Ninety-six patients were included. Eleven patients (11.5%) had an amputation and 14 (14.6%) died. In the logistic regression model for amputation, patients with ischemia duration greater than 6 hours were approximately 10 times more likely to undergo an amputation compared to those with ischemia duration less than or equal to 6 hours (adjusted odds ratio (AOR) [95% confidence interval (CI)]: 9.6 [1.2-79.9]). The logistic regression model for mortality revealed that patients with ischemia duration greater than 6 hours were approximately 6 times more likely to die compared to those with ischemia duration less than or equal to 6 hours (AOR [95% CI]: 5.6 [1.3 to 24.7).

Conclusions: Ischemia duration remains the most important factor independently associated with limb loss and mortality for patients undergoing femoropopliteal arterial revascularization after traumatic injuries. Physiological status on admission and trauma scores are also important.

Keywords

femoral artery, popliteal artery, injury, trauma

Resumo

Resumo: Contexto: As lesões arteriais traumáticas de membros ainda permanecem uma causa significativa de perda de membros e mortalidade, apesar de melhorias significativas observadas nos resultados após a ocorrências dessas lesões.

Objetivos: Este estudo buscou identificar preditores de mortalidade e amputações em pacientes submetidos à revascularização após trauma arterial femoropoplíteo.

Métodos: Esta é uma revisão de um Registro de Trauma Vascular. Todos os pacientes com lesão arterial femoropoplítea internados em nosso hospital de novembro de 2012 a dezembro de 2017 e submetidos a reconstrução vascular foram incluídos. Análises univariadas, seguidas de análises de regressão logística, foram realizadas para identificar fatores independentemente associados com os resultados primários de amputação e mortalidade.

Resultados: Foram incluídos 96 pacientes, com média de 27 anos. O Revised Trauma Score (RTS) foi, em média, 7,152; já o Injury Severity Score (ISS) foi, em média, 15. Onze pacientes (11,5%) tiveram amputação, e 14 pacientes (14,6%) morreram. Observou-se que pacientes com o tempo de isquemia maior que 6 horas apresentaram aproximadamente 10 vezes mais chance de amputação do que aqueles com tempo igual ou menor que 6 horas (intervalo de confiança de 95% [IC95%]: 1,2 a 79,9). O tempo de isquemia maior que 6 horas aumentou em aproximadamente 6 vezes a chance de mortalidade (IC95%: 1,26 a 24,77). A instabilidade hemodinâmica aumentou em 9 vezes a chance de mortalidade (IC95%: 2,36 a 36,67).

Conclusões: O tempo de isquemia continua sendo o fator mais importante independentemente associado a amputação e óbito em pacientes submetidos à revascularização arterial femoropoplítea após traumas. O estado fisiológico e os escores de trauma são importantes.
 

Palavras-chave

artéria femoral, artéria poplítea, lesão, trauma

References

1 Hashmi ZG, Haider AH, Zafar SN, et al. Hospital-based trauma quality improvement iatives: first step toward improving trauma outcomes in the developing world. J Trauma Acute Care Surg. 2013;75(1):60-8. http://dx.doi.org/10.1097/TA.0b013e31829880a0. PMid:23778440.

2 Sonneborn R, Andrade R, Bello F, et al. Vascular trauma in Latin America: a regional survey. Surg Clin North Am. 2002;82(1):189-94. http://dx.doi.org/10.1016/S0039-6109(03)00148-8. PMid:11905945.

3 Topal AE, Eren MN, Celik Y. Lower extremity arterial injuries over a six-year period: outcomes, risk factors, and management. Vasc Health Risk Manag. 2010;6:1103-10. http://dx.doi.org/10.2147/VHRM.S15316. PMid:21191430.

4 Debakey ME, Simeone FA. Battle injuries of the arteries in World War II: an analysis of 2,471 cases. Ann Surg. 1946;123(4):534-79. http://dx.doi.org/10.1097/00000658-194604000-00005. PMid:17858758.

5 Góes AMO Jr, Rodrigues ADV, Braga FB, Andrade MCD, Abib SDCV. Vascular trauma in the Amazon: the challenge of great distances. Rev Col Bras Cir. 2015;42(4):244-52. http://dx.doi.org/10.1590/0100-69912015004009. PMid:26517800.

6 Costa-Val R, Campos-Christo SF, Abrantes WL, Campos-Christo MB, Marques MC, Miguel EV. Reflexões sobre o trauma cardiovascular civil a partir de um estudo prospectivo de 1000 casos atendidos em um centro de trauma de nível I: a prospective study from 1000 cases. Rev Col Bras Cir. 2008;35(3):162-7. http://dx.doi.org/10.1590/S0100-69912008000300005.

7 Góes AMO Jr, Simões JFA No, Abib SCV, de-Andrade MC, Ferraz TC. Trauma vascular na Amazônia: atualizando o desafio. Rev Col Bras Cir. 2018;45(4):e1844. PMid:30304097.

8 Senefonte FRA, Rosa GRPS, Comparin ML, et al. Amputação primária no trauma: perfil de um hospital da região centro-oeste do Brasil. J Vasc Bras. 2012;11(4):269-76. http://dx.doi.org/10.1590/S1677-54492012000400004.

9 Soares LT, Bastos CC, Koury A Jr, Pereira AJF. Vascular injuries in the state of Para, Brazil, 2011-2013 and their relation with demographic and clinical variables. J Vasc Bras. 2015;14(2):123-32. http://dx.doi.org/10.1590/1677-5449.0042.

10 Agha R, Abdall-Razak A, Crossley E, et al. The STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery. Int J Surg. 2019;72:156-65. http://dx.doi.org/10.1016/j.ijsu.2019.11.002. PMid:31704426.

11 Perkins ZB, Yet B, Glasgow S, et al. Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma. Br J Surg. 2015;102(5):436-50. http://dx.doi.org/10.1002/bjs.9689. PMid:25706113.

12 Alarhayem AQ, Cohn SM, Cantu-Nunez O, Eastridge BJ, Rasmussen TE. Impact of time to repair on outcomes in patients with lower extremity arterial injuries. J Vasc Surg. 2019;69(5):1519-23. http://dx.doi.org/10.1016/j.jvs.2018.07.075. PMid:30497861.

13 Futchko J, Parsikia A, Berezin N, et al. A propensity-matched analysis of contemporary outcomes of blunt popliteal artery injury. J Vasc Surg. 2020;72(1):189-97. http://dx.doi.org/10.1016/j.jvs.2019.09.048. PMid:32247701.

14 Perkins ZB, De’Ath HD, Aylwin C, Brohi K, Walsh M, Tai NRM. Epidemiology and outcome of vascular trauma at a british major trauma centre. Eur J Vasc Endovasc Surg. 2012;44(2):203-9. http://dx.doi.org/10.1016/j.ejvs.2012.05.013. PMid:22658774.

15 Velmahos GC, Toutouzas KG. Vascular trauma and compartment syndromes. Surg Clin North Am. 2002;82(1):125-41, xxi. http://dx.doi.org/10.1016/S0039-6109(03)00145-2. PMid:11905942.

16 Drost TF, Rosemurgy AS, Proctor D, Kearney RE. Outcome of treatment of combined orthopedic and arterial trauma to the lower extremity. J Trauma Inj Infect Crit Care. 1989;29(10):1331-4. http://dx.doi.org/10.1097/00005373-198910000-00006. PMid:2810407.

17 Kauvar DS, Sarfati MR, Kraiss LW. National trauma databank analysis of mortality and limb loss in isolated lower extremity vascular trauma. J Vasc Surg. 2011;53(6):1598-603. http://dx.doi.org/10.1016/j.jvs.2011.01.056. PMid:21514772.

18 Teixeira PGR, Brown CVR, Emigh B, et al. Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury. J Am Coll Surg. 2018;226(5):769-776.e1. http://dx.doi.org/10.1016/j.jamcollsurg.2018.01.047. PMid:29605726.

19 Lei R, Swartz MD, Harvin JA, et al. Stop the Bleed Training empowers learners to act to prevent unnecessary hemorrhagic death. Am J Surg. 2019;217(2):368-72. http://dx.doi.org/10.1016/j.amjsurg.2018.09.025. PMid:30292328.

20 Glass GE, Pearse MF, Nanchahal J. Improving lower limb salvage following fractures with vascular injury: a systematic review and new management algorithm. J Plast Reconstr Aesthet Surg. 2009;62(5):571-9. http://dx.doi.org/10.1016/j.bjps.2008.11.117. PMid:19201270.

21 Inaba K, Aksoy H, Seamon MJ, et al. Multicenter evaluation of temporary intravascular shunt use in vascular trauma. J Trauma Acute Care Surg. 2016;80(3):359-64. http://dx.doi.org/10.1097/TA.0000000000000949. PMid:26713968.
 


Submitted date:
03/14/2022

Accepted date:
07/13/2022

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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