Management of distal femoral and popliteal arterial injuries

an update

Tam T T Huynh, Mai Pham, Lance Griffin, Martin A. Villa, J. Alan Przybyla, Ricardo H. Torres, Kourosh Keyhani, Hazim J. Safi, Frederick A. Moore

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background: The management of combined arterial and musculoskeletal injuries to the lower extremity remains controversial, particularly with regard to the initial order of intervention and the use of intravascular shunting. In this study, we review the contemporary management and outcome of patients treated for acute traumatic distal femoropopliteal arterial injuries. Methods: From January 2001 to January 2006, we repaired 57 acute traumatic lower-extremity arterial injuries in a level 1 trauma center. Our approach was to perform surgical revascularization without intraluminal shunting as soon as the arterial injury was recognized. There were 44 men (77%). Mean age was 31 years (range, 5-68). The mechanism of injury was blunt in 42 of 57 (74%) patients. Vascular reconstruction was achieved by using an autogenous saphenous vein graft in 52 of 57 (91%), a vein patch in 3 of 57 (5%), or primarily in 2 of 57 (4%) patients. Results: The limb-salvage rate was 92% (53/57). Thirty-six patients (63%) had associated orthopedic fixation: 12 of 36 (33%) before and 24 of 36 (67%) after revascularization. Twenty-one of 57 patients (37%) had vascular repair only without orthopedic fixation. Thirty-four patients (60%) required fasciotomy. Four patients had subsequent above-knee amputation: 3 because of wound complications despite successful revascularization and 1 because of failed revascularization. There were no complications related to the arterial repairs that were performed before orthopedic fixation. Conclusion: Our study shows that arterial reconstruction for acute traumatic lower-limb injuries results in a good limb-salvage rate. We advocate prompt vascular repair before orthopedic intervention for combined vascular and skeletal injuries of the lower extremity, without using intravascular shunting.

Original languageEnglish (US)
Pages (from-to)773-778
Number of pages6
JournalAmerican Journal of Surgery
Volume192
Issue number6
DOIs
StatePublished - Dec 2006
Externally publishedYes

Fingerprint

Thigh
Wounds and Injuries
Orthopedics
Lower Extremity
Blood Vessels
Limb Salvage
Nonpenetrating Wounds
Trauma Centers
Vascular System Injuries
Saphenous Vein
Amputation
Veins
Knee
Transplants

Keywords

  • Leg
  • Orthopedic
  • Popliteal
  • Shunt
  • Trauma
  • Vascular

ASJC Scopus subject areas

  • Surgery

Cite this

Huynh, T. T. T., Pham, M., Griffin, L., Villa, M. A., Przybyla, J. A., Torres, R. H., ... Moore, F. A. (2006). Management of distal femoral and popliteal arterial injuries: an update. American Journal of Surgery, 192(6), 773-778. https://doi.org/10.1016/j.amjsurg.2006.08.043

Management of distal femoral and popliteal arterial injuries : an update. / Huynh, Tam T T; Pham, Mai; Griffin, Lance; Villa, Martin A.; Przybyla, J. Alan; Torres, Ricardo H.; Keyhani, Kourosh; Safi, Hazim J.; Moore, Frederick A.

In: American Journal of Surgery, Vol. 192, No. 6, 12.2006, p. 773-778.

Research output: Contribution to journalArticle

Huynh, TTT, Pham, M, Griffin, L, Villa, MA, Przybyla, JA, Torres, RH, Keyhani, K, Safi, HJ & Moore, FA 2006, 'Management of distal femoral and popliteal arterial injuries: an update', American Journal of Surgery, vol. 192, no. 6, pp. 773-778. https://doi.org/10.1016/j.amjsurg.2006.08.043
Huynh, Tam T T ; Pham, Mai ; Griffin, Lance ; Villa, Martin A. ; Przybyla, J. Alan ; Torres, Ricardo H. ; Keyhani, Kourosh ; Safi, Hazim J. ; Moore, Frederick A. / Management of distal femoral and popliteal arterial injuries : an update. In: American Journal of Surgery. 2006 ; Vol. 192, No. 6. pp. 773-778.
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abstract = "Background: The management of combined arterial and musculoskeletal injuries to the lower extremity remains controversial, particularly with regard to the initial order of intervention and the use of intravascular shunting. In this study, we review the contemporary management and outcome of patients treated for acute traumatic distal femoropopliteal arterial injuries. Methods: From January 2001 to January 2006, we repaired 57 acute traumatic lower-extremity arterial injuries in a level 1 trauma center. Our approach was to perform surgical revascularization without intraluminal shunting as soon as the arterial injury was recognized. There were 44 men (77{\%}). Mean age was 31 years (range, 5-68). The mechanism of injury was blunt in 42 of 57 (74{\%}) patients. Vascular reconstruction was achieved by using an autogenous saphenous vein graft in 52 of 57 (91{\%}), a vein patch in 3 of 57 (5{\%}), or primarily in 2 of 57 (4{\%}) patients. Results: The limb-salvage rate was 92{\%} (53/57). Thirty-six patients (63{\%}) had associated orthopedic fixation: 12 of 36 (33{\%}) before and 24 of 36 (67{\%}) after revascularization. Twenty-one of 57 patients (37{\%}) had vascular repair only without orthopedic fixation. Thirty-four patients (60{\%}) required fasciotomy. Four patients had subsequent above-knee amputation: 3 because of wound complications despite successful revascularization and 1 because of failed revascularization. There were no complications related to the arterial repairs that were performed before orthopedic fixation. Conclusion: Our study shows that arterial reconstruction for acute traumatic lower-limb injuries results in a good limb-salvage rate. We advocate prompt vascular repair before orthopedic intervention for combined vascular and skeletal injuries of the lower extremity, without using intravascular shunting.",
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AU - Keyhani, Kourosh

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