Hemingway Jake, Adjei Enock, Desikan Sarasijhaa, Gross Joel, Tran Nam, Singh Niten, Starnes Benjamin, Quiroga Elina
Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA.
Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA.
Ann Vasc Surg. 2020 Jan;62:106-113. doi: 10.1016/j.avsg.2019.05.052. Epub 2019 Aug 6.
Current algorithms for the management of blunt lower extremity trauma recommend additional imaging in patients presenting with soft signs of vascular injury and an ankle-brachial index (ABI) less than 0.9. The aim of this study is to analyze lower extremity computed tomography angiographies (CTAs) to determine the incidence and characteristics of patients sustaining vascular injury from blunt lower extremity trauma. We hypothesized that a lower ABI threshold can avoid unnecessary imaging without missing clinically significant vascular injury.
A single-center, retrospective review of all consecutive patients who presented to a level 1 trauma center with blunt lower extremity trauma and underwent a CTA from January 2015 to December 2017 was conducted. Baseline demographics, clinical features, and outcomes were recorded. Patients without documented ABIs were excluded. A receiver operating characteristic curve was used to define the ABI threshold.
One hundred twenty-five patients (133 injured limbs) met inclusion criteria. The mean age was 44 years (range 9-96), and 74% of the patients were male. A vascular abnormality was identified on CTA in 65 limbs (48.9%), of which only 8 (12%) required intervention. The ABIs in these 8 injured limbs were between 0 and 0.6. An ABI threshold of 0.6 maximized the balance between sensitivity (100%) and specificity (87%) and missed no injuries requiring revascularization.
The ABI remains useful in evaluating blunt lower extremity trauma. A lower ABI threshold in patients presenting with soft signs of vascular injury after blunt trauma may avoid unnecessary imaging without missing vascular injuries requiring intervention. Further prospective studies are needed to validate the safety and effectiveness of a lower ABI threshold.
目前针对钝性下肢创伤的处理算法建议，对于出现血管损伤软体征且踝肱指数（ABI）小于0.9的患者，应进行额外的影像学检查。本研究的目的是分析下肢计算机断层血管造影（CTA），以确定钝性下肢创伤所致血管损伤患者的发生率及特征。我们假设较低的ABI阈值可避免不必要的影像学检查，同时又不会遗漏具有临床意义的血管损伤。
对2015年1月至2017年12月期间在一级创伤中心就诊、因钝性下肢创伤接受CTA检查的所有连续患者进行单中心回顾性研究。记录基线人口统计学资料、临床特征及结局。排除未记录ABI的患者。采用受试者工作特征曲线确定ABI阈值。
125例患者（133条受伤肢体）符合纳入标准。平均年龄为44岁（范围9 - 96岁），74%的患者为男性。CTA检查发现65条肢体（48.9%）存在血管异常，其中仅8条（12%）需要干预。这8条受伤肢体的ABI在0至0.6之间。ABI阈值为0.6时，在敏感性（100%）和特异性（87%）之间取得了最佳平衡，且未遗漏任何需要血管重建的损伤。
ABI在评估钝性下肢创伤方面仍然有用。对于钝性创伤后出现血管损伤软体征的患者，较低的ABI阈值可避免不必要的影像学检查，同时又不会遗漏需要干预的血管损伤。需要进一步的前瞻性研究来验证较低ABI阈值的安全性和有效性。
