Management of Femoropopliteal Vascular Injuries after Trauma: Surgical Outcomes

Chang, Sung Wook; Han, Sun; Ryu, Kyoung Min; Ryu, Jae Wook

Abstract

PURPOSE
Vascular injuries caused by traffic, industrial accidents and by outside activities have increased in Korea. Especially, vascular injuries to the extremities can lead to limb loss and even mortality if they are not appropriately treated. The aim of the study was to evaluate the surgical outcomes of femoropopliteal vascular management after trauma.
METHODS
The medical records of 12 patients with femoropopliteal vascular injuries who were treated at Dankook University Hospital from 2011 to 2013 were reviewed. Iatrogenic vascular injuries were excluded. The clinical data including the causes of injury, associated injuries and surgical outcomes were analyzed retrospectively.
RESULTS
All patients were male, with a mean age of 46.8+/-16.3 years (range: 26~69 years). The causes of vascular injuries were four traffic accidents, three industrial accidents, two iron plates, one outside activity, one glass injury and one knife injury. The average transit time between the place of the accident place and the emergency department was 3.0+/-2.1 (0.5~12.5) hours, and the average preparation time for surgery was 8.0+/-6.7 (1.7~23.3) hours. The anatomic injuries included the popliteal vessel in seven cases and the femoral vessel in five cases. The average Injury Severity Score (ISS) was 12.0+/-5.0 (5~17), and the average Mangled Extremity Severity Score (MESS) was 5.7+/-2.1 (2~9). The operation methods were four interposition grafts, three end-to-end anastomoses, two direct repairs and three patch angioplasties. One case required amputation of the injured extremity.
CONCLUSION
Early recognition and revascularization of the injured vessel are mandatory to reduce limb loss and to obtain satisfactory outcomes. Therefore, careful/rapid evaluation of the vascular injuries and timely/successful surgical treatment are the keys to salvaging an injured limb.