학술논문
Current outcomes following upper and lower extremity arterial trauma from the National Trauma Data Bank.
Document Type
Academic Journal
Author
Kim S; Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.; Schneider A; Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.; Raulli S; Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.; Ruiz C; Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.; Marston W; Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.; McGinigle KL; Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.; Wood J; Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.; Parodi FE; Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.; Farber MA; Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.; Pascarella L; Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC. Electronic address: luigi_pascarella@med.unc.edu.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 8407742 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6809 (Electronic) Linking ISSN: 07415214 NLM ISO Abbreviation: J Vasc Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: The modern treatments of trauma have changed in recent years. We aim to evaluate the factors associated with limb salvage and mortality after extremity arterial trauma, especially with respect to the type of conduit used in revascularization.
Methods: The National Trauma Data Bank was queried to identify patients with upper and lower extremity (UE and LE) arterial injuries between 2016 and 2020. The patients were stratified by the types of arterial repair. The primary outcome was in-hospital mortality.
Results: 8780 patients were found with 5054 (58%) UE and 3726 (42%) LE injuries. Eighty-three percent were men, and the mean age was 34 ± 15 years. Penetrating mechanism was the predominant mode of injury in both UEs and LEs (73% and 67%, respectively) with a mean injury severity score of 14 ± 8. For UEs, the majority underwent primary repair (67%, P < .001), whereas the remainder received either a bypass (20%) or interposition graft (12%). However, LEs were more likely to receive a bypass (52%, P < .00001) than primary repair or interposition graft (34% and 14%, respectively). Compared with the extremely low rates of amputation and mortality among UE patients (2% for both), LE injuries were more likely to result in both amputation (10%, P < .001) and death (6%, P < .001). Notably, compared with primary repair, the use of a prosthetic conduit was associated with a 6.7-fold increase in the risk of amputation in UE and a 2.4-fold increase in LE (P < .0001 for both). Synthetic bypasses were associated with a nearly 3-fold increase in return to the operating room (OR) in UE bypasses (P < .05) and a 2.4-fold increase in return to the OR in LE bypasses (P < .0001).
Conclusions: In recent years, most extremity vascular trauma was due to penetrating injury with a substantial burden of morbidity and mortality. However, both limb salvage rates and survival rates have remained high. Overall, LE injuries more often led to amputation and mortality than UE injuries. The most frequently used bypass conduit was vein, which was associated with less risk of unplanned return to the OR and limb loss, corroborating current practice guidelines for extremity arterial trauma.
Competing Interests: Disclosures None.
(Copyright © 2024 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
Methods: The National Trauma Data Bank was queried to identify patients with upper and lower extremity (UE and LE) arterial injuries between 2016 and 2020. The patients were stratified by the types of arterial repair. The primary outcome was in-hospital mortality.
Results: 8780 patients were found with 5054 (58%) UE and 3726 (42%) LE injuries. Eighty-three percent were men, and the mean age was 34 ± 15 years. Penetrating mechanism was the predominant mode of injury in both UEs and LEs (73% and 67%, respectively) with a mean injury severity score of 14 ± 8. For UEs, the majority underwent primary repair (67%, P < .001), whereas the remainder received either a bypass (20%) or interposition graft (12%). However, LEs were more likely to receive a bypass (52%, P < .00001) than primary repair or interposition graft (34% and 14%, respectively). Compared with the extremely low rates of amputation and mortality among UE patients (2% for both), LE injuries were more likely to result in both amputation (10%, P < .001) and death (6%, P < .001). Notably, compared with primary repair, the use of a prosthetic conduit was associated with a 6.7-fold increase in the risk of amputation in UE and a 2.4-fold increase in LE (P < .0001 for both). Synthetic bypasses were associated with a nearly 3-fold increase in return to the operating room (OR) in UE bypasses (P < .05) and a 2.4-fold increase in return to the OR in LE bypasses (P < .0001).
Conclusions: In recent years, most extremity vascular trauma was due to penetrating injury with a substantial burden of morbidity and mortality. However, both limb salvage rates and survival rates have remained high. Overall, LE injuries more often led to amputation and mortality than UE injuries. The most frequently used bypass conduit was vein, which was associated with less risk of unplanned return to the OR and limb loss, corroborating current practice guidelines for extremity arterial trauma.
Competing Interests: Disclosures None.
(Copyright © 2024 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)