Abstract
Objectives
Infra-inguinal vascular injuries (IIVI) are emergencies involving both functional
and vital prognosis. The choice between saving the limb or doing a first-line amputation
is difficult even for an experienced surgeon. The aims of this work are to analyze
early outcomes in our center and to identify predictive factors for amputation. M
Methods
Between 2010 and 2017, we reviewed retrospectively patients with IIVI. The main criteria
for judgement were: primary, secondary and overall amputation.
Two groups of potential risk factors of amputation were analyzed: Those related to
the patient: age, shock, ISS score; those related to the lesion: mechanism, above
or below the knee, bone lesions, venous lesions and skin decay. A univariate and multivariate
analysis were performed to determine the risk factor(s) independently associated with
the occurrence of amputation.
Results
57 IIVI were found in 54 patients. The mean ISS was 32,3 ± 21. A primary amputation
was performed in 19%, and secondary in 14% of cases. Overall amputation rate was 35%
(n=19). Multivariate analysis reveals that the ISS is the only predictor of primary
(p=0.009; OR:1.07; CI:1.01-1.12) and global (p=0.04; OR:1.07; IC:1.02-1.13) amputation. A threshold value of 41 was selected as
a primary amputation risk factor with a negative predictive value of 97%.
Conclusions
The ISS is a good predictor of the risk of amputation in IIVI. A threshold of 41 is
an objective criterion helping to decide for a first-line amputation. Advanced age
and hemodynamic instability should not be important in the decision tree.
Key words
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Article info
Publication history
Accepted:
February 28,
2023
Received in revised form:
February 27,
2023
Received:
December 14,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Meeting.— The abstract of this paper was presented at to the French society for vascular and endovascular surgery meeting in Lille on October 2019. Volume 60, P19-20, October 01, 2019 https://doi.org/10.1016/j.avsg.2019.08.038
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
