O'Banion Leigh Ann, Dirks Rachel, Saldana-Ruiz Nallely, Farooqui Emaad, Yoon William J, Pozolo Cara, Fox Charles J, Crally Alexis, Siada Sammy, Nehler Mark R, Brooke Benjamin S, Beckstrom Julie L, Kiang Sharon, Boggs Hans K, Chandra Venita, Ho Vy T, Zhou Wei, Lee Ashton, Bowens Nina, Cho Yan, Woo Karen, Ulloa Jesus, Magee Gregory A
Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, Fresno, Calif. Electronic address: leighann.o'
Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, Fresno, Calif.
J Vasc Surg. 2021 Nov;74(5):1573-1580.e2. doi: 10.1016/j.jvs.2021.04.064. Epub 2021 May 21.
Traumatic popliteal artery injuries are associated with the greatest risk of limb loss of all peripheral vascular injuries, with amputation rates of 10% to 15%. The purpose of the present study was to examine the outcomes of patients who had undergone operative repair for traumatic popliteal arterial injuries and identify the factors independently associated with limb loss.
A multi-institutional retrospective review of all patients with traumatic popliteal artery injuries from 2007 to 2018 was performed. All the patients who had undergone operative repair of popliteal arterial injuries were included in the present analysis. The patients who had required a major lower extremity amputation (transtibial or transfemoral) were compared with those with successful limb salvage at the last follow-up. The significant predictors (P < .05) for amputation on univariate analysis were included in a multivariable analysis.
A total of 302 patients from 11 institutions were included in the present analysis. The median age was 32 years (interquartile range, 21-40 years), and 79% were men. The median follow-up was 72 days (interquartile range, 20-366 days). The overall major amputation rate was 13%. Primary repair had been performed in 17% of patients, patch repair in 2%, and interposition or bypass in 81%. One patient had undergone endovascular repair with stenting. The overall 1-year primary patency was 89%. Of the patients who had lost primary patency, 46% ultimately required major amputation. Early loss (within 30 days postoperatively) of primary patency was five times more frequent for the patients who had subsequently required amputation. On multivariate regression, the significant perioperative factors independently associated with major amputation included the initial POPSAVEIT (popliteal scoring assessment for vascular extremity injury in trauma) score, loss of primary patency, absence of detectable immediate postoperative pedal Doppler signals, and lack of postoperative antiplatelet therapy. Concomitant popliteal vein injury, popliteal injury location (P1, P2, P3), injury severity score, and tibial vs popliteal distal bypass target were not independently associated with amputation.
Traumatic popliteal artery injuries are associated with a significant rate of major amputation. The preoperative POPSAVEIT score remained independently associated with amputation after including the perioperative factors. The lack of postoperative pedal Doppler signals and loss of primary patency were highly associated with major amputation. The use of postoperative antiplatelet therapy was inversely associated with amputation, perhaps indicating a protective effect.
在所有外周血管损伤中，创伤性腘动脉损伤导致肢体丧失的风险最高，截肢率为10%至15%。本研究的目的是检查接受创伤性腘动脉损伤手术修复患者的预后，并确定与肢体丧失独立相关的因素。
对2007年至2018年所有创伤性腘动脉损伤患者进行多机构回顾性研究。本分析纳入了所有接受腘动脉损伤手术修复的患者。将需要进行下肢大截肢（经胫骨或经股骨）的患者与最后一次随访时成功保肢的患者进行比较。单因素分析中截肢的显著预测因素（P <.05）纳入多变量分析。
本分析共纳入了来自11个机构的302例患者。中位年龄为32岁（四分位间距，21 - 40岁），79%为男性。中位随访时间为72天（四分位间距，20 - 366天）。总体大截肢率为13%。17%的患者进行了一期修复，2%进行了补片修复，81%进行了血管移植或旁路手术。1例患者接受了带支架的血管腔内修复。总体1年一期通畅率为89%。在一期通畅丧失的患者中，46%最终需要进行大截肢。随后需要截肢的患者一期通畅早期丧失（术后30天内）的频率是其他患者的5倍。多变量回归分析显示，与大截肢独立相关的显著围手术期因素包括初始POPSAVEIT（创伤性血管肢体损伤腘动脉评分评估）评分、一期通畅丧失、术后即刻未检测到足背多普勒信号以及缺乏术后抗血小板治疗。腘静脉合并损伤、腘动脉损伤部位（P1、P2、P3）、损伤严重程度评分以及胫骨与腘动脉远端旁路目标与截肢无独立相关性。
创伤性腘动脉损伤与较高的大截肢率相关。纳入围手术期因素后，术前POPSAVEIT评分仍与截肢独立相关。术后足背多普勒信号缺失和一期通畅丧失与大截肢高度相关。术后抗血小板治疗的使用与截肢呈负相关，可能表明具有保护作用。
