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

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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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