Asensio Juan A, Kessler John J, Miljkovic Stephanie S, Kotaru Tharun R, Dabestani Parinaz J, Kalamchi Louay D, Wenzl Florian A, Sanford Arthur P, Rowe Vincent L
Department of Surgery, Creighton University School of Medicine, Omaha, NE.
Department of Surgery, Creighton University School of Medicine, Omaha, NE.
Ann Vasc Surg. 2020 Nov;69:146-157. doi: 10.1016/j.avsg.2020.05.049. Epub 2020 Jun 2.
Brachial artery injuries are rare. The objectives of the study are to report our experience and identify predictors of outcome. The hypothesis of the study is that maintaining ischemic times less than six hours results in improved outcomes.
This is a retrospective 118-month study. The outcome measure is total operative time from admission to restoration of blood flow, and outcomes are survival and limb salvage. Statistical analyses used in the study are univariate and multivariate stepwise logistic regression.
There were 124 patients with 131 brachial artery injuries. Mechanism of injury (MOI) included the following: penetrating: 108 (87%) and blunt: 16 (13%). Operative management included the following: 77 (62%) reverse saphenous vein interposition grafts, 37 (29.8%) end-to-end anastomosis, and 4 (3.2%) ligation. Fasciotomies were performed in 23 (19.2%) patients. Outcomes of the study were as follows: 120 patients survived and the overall survival rate was 96.8%, adjusted survival rate excluding intraoperative deaths was 100%, overall limb salvage/amputation rate was 95.1%/4.9%, and adjusted limb salvage/amputation rates excluding intraoperative deaths were 98.3%/1.67%. Univariate analysis showed the mean ischemic times for survivors as 5 ± 3.1 hrs (300 ± 186 min) versus ischemic times for non survivors as 3 ± 2.2 hrs (180 ± 132 min) (P = 0.017); Injury Severity Score (ISS) (P = 0.002); and estimated blood loss (EBL) (P = 0.024). Logistic regression identified independent predictors of outcome for survival: MOI: penetrating [P = 0.015, RR - 4.29, 95% CI: 1.49-12.36]; Glasgow Coma Score < 7 [P < 0.001, RR - 21.71, 95% CI: 9.37-50.32]; ISS > 15 [P < 0.005, RR - 4.98, 95% CI: 1.68-14.73]; and patients not requiring ED thoracotomy [P = 0.009, RR - 7.48, 95% CI: 2.58-21.69].
Brachial artery injuries are rare. For patients not requiring ED thoracotomy, Glasgow Coma Score, ISS, and EBL predicted survival. The adjusted limb salvage rate was 98.3%. Patients with brachial artery injuries die from associated injuries, experiencing less ischemic times than survivors who are able to undergo repairs.
肱动脉损伤较为罕见。本研究的目的是报告我们的经验并确定预后的预测因素。该研究的假设是，将缺血时间维持在6小时以内可改善预后。
这是一项为期118个月的回顾性研究。结局指标是从入院到恢复血流的总手术时间，结局为生存和肢体保全。本研究中使用的统计分析方法是单因素和多因素逐步逻辑回归。
共有124例患者发生131处肱动脉损伤。损伤机制（MOI）包括以下几种：穿透伤：108例（87%），钝性伤：16例（13%）。手术治疗包括以下几种：77例（62%）采用大隐静脉逆行移植术，37例（29.8%）采用端端吻合术，4例（3.2%）采用结扎术。23例（19.2%）患者进行了筋膜切开术。研究结果如下：120例患者存活，总体生存率为96.8%，排除术中死亡后的调整后生存率为100%，总体肢体保全/截肢率为95.1%/4.9%，排除术中死亡后的调整后肢体保全/截肢率为98.3%/1.67%。单因素分析显示，存活者的平均缺血时间为5±3.1小时（300±186分钟），而非存活者的缺血时间为3±2.2小时（180±132分钟）（P = 0.017）；损伤严重度评分（ISS）（P = 0.002）；以及估计失血量（EBL）（P = 0.024）。逻辑回归确定了生存结局的独立预测因素：损伤机制：穿透伤[P = 0.015，RR - 4.29，95% CI：1.49 - 12.36]；格拉斯哥昏迷评分<7[P < 0.001，RR - 21.71，95% CI：9.37 - 50.32]；ISS>15[P < 0.005，RR - 4.98，95% CI：1.68 - 14.73]；以及不需要急诊开胸手术的患者[P = 0.009，RR - 7.48，95% CI：2.58 - 21.69]。
肱动脉损伤较为罕见。对于不需要急诊开胸手术的患者，格拉斯哥昏迷评分、ISS和EBL可预测生存情况。调整后的肢体保全率为98.3%。肱动脉损伤患者死于相关损伤，其缺血时间比能够接受修复手术的存活者短。
