Observation may be an inadequate approach for injured extremities with single tibial vessel run-off

Anahita Dua, Sapan S. Desai, Sean Johnston, Naga R. Chinapuvvula, Joseph DuBose, Kristofer Charlton-Ouw, Ali Azizzadeh, Andrew Burgess, Charles E. Wade, Charles J. Fox, John B. Holcomb

Research output: Contribution to journalArticle

Abstract

Introduction Trauma patients with sudden loss of distal perfusion due to tibial injuries are frequently not offered vascular interventions if a single vessel retains patency. We hypothesized that sudden loss of either all or some tibial vasculature would result in increased non-operative failure and higher amputation rates. Methods In this retrospective observational study, all traumatically injured patients from 2009 to 2012 with CT-angiogram–confirmed anterior tibial, posterior tibial, or peroneal artery injuries were included. Results From 2009 to 2012, 437 patients were admitted with arterial extremity injury of which 234 (53%) were lower extremity. From this group, 84 (36%) patients were identified with CT-angiogram–confirmed limited or no flow in the tibial arteries. A total of 44% (4/9) with 0 or 1 tibial vessel failed observation while only 8% (2/27) failed if they had 2 or 3 patent vessels (p <0.05). Amputation rate was inversely related the number of open tibial vessels. There were 2.7 open tibial vessels in the limb salvage group compared to 1.1 in the amputation group (p <0.05). Conclusion Patients who failed an initial trial of observation were significantly more likely to have 0 or 1 tibial vessels patent. The number of open tibial vessels is significantly associated with limb salvage.

Original languageEnglish (US)
Pages (from-to)468-473
Number of pages6
JournalVascular
Volume23
Issue number5
DOIs
StatePublished - Oct 29 2015
Externally publishedYes

Fingerprint

Extremities
Observation
Amputation
Limb Salvage
Wounds and Injuries
Tibial Arteries
Observational Studies
Blood Vessels
Lower Extremity
Retrospective Studies
Arteries
Perfusion

Keywords

  • amputation
  • revascularization
  • Tibial vessels
  • trauma

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Surgery

Cite this

Dua, A., Desai, S. S., Johnston, S., Chinapuvvula, N. R., DuBose, J., Charlton-Ouw, K., ... Holcomb, J. B. (2015). Observation may be an inadequate approach for injured extremities with single tibial vessel run-off. Vascular, 23(5), 468-473. https://doi.org/10.1177/1708538114554925

Observation may be an inadequate approach for injured extremities with single tibial vessel run-off. / Dua, Anahita; Desai, Sapan S.; Johnston, Sean; Chinapuvvula, Naga R.; DuBose, Joseph; Charlton-Ouw, Kristofer; Azizzadeh, Ali; Burgess, Andrew; Wade, Charles E.; Fox, Charles J.; Holcomb, John B.

In: Vascular, Vol. 23, No. 5, 29.10.2015, p. 468-473.

Research output: Contribution to journalArticle

Dua, A, Desai, SS, Johnston, S, Chinapuvvula, NR, DuBose, J, Charlton-Ouw, K, Azizzadeh, A, Burgess, A, Wade, CE, Fox, CJ & Holcomb, JB 2015, 'Observation may be an inadequate approach for injured extremities with single tibial vessel run-off', Vascular, vol. 23, no. 5, pp. 468-473. https://doi.org/10.1177/1708538114554925
Dua A, Desai SS, Johnston S, Chinapuvvula NR, DuBose J, Charlton-Ouw K et al. Observation may be an inadequate approach for injured extremities with single tibial vessel run-off. Vascular. 2015 Oct 29;23(5):468-473. https://doi.org/10.1177/1708538114554925
Dua, Anahita ; Desai, Sapan S. ; Johnston, Sean ; Chinapuvvula, Naga R. ; DuBose, Joseph ; Charlton-Ouw, Kristofer ; Azizzadeh, Ali ; Burgess, Andrew ; Wade, Charles E. ; Fox, Charles J. ; Holcomb, John B. / Observation may be an inadequate approach for injured extremities with single tibial vessel run-off. In: Vascular. 2015 ; Vol. 23, No. 5. pp. 468-473.
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abstract = "Introduction Trauma patients with sudden loss of distal perfusion due to tibial injuries are frequently not offered vascular interventions if a single vessel retains patency. We hypothesized that sudden loss of either all or some tibial vasculature would result in increased non-operative failure and higher amputation rates. Methods In this retrospective observational study, all traumatically injured patients from 2009 to 2012 with CT-angiogram–confirmed anterior tibial, posterior tibial, or peroneal artery injuries were included. Results From 2009 to 2012, 437 patients were admitted with arterial extremity injury of which 234 (53{\%}) were lower extremity. From this group, 84 (36{\%}) patients were identified with CT-angiogram–confirmed limited or no flow in the tibial arteries. A total of 44{\%} (4/9) with 0 or 1 tibial vessel failed observation while only 8{\%} (2/27) failed if they had 2 or 3 patent vessels (p <0.05). Amputation rate was inversely related the number of open tibial vessels. There were 2.7 open tibial vessels in the limb salvage group compared to 1.1 in the amputation group (p <0.05). Conclusion Patients who failed an initial trial of observation were significantly more likely to have 0 or 1 tibial vessels patent. The number of open tibial vessels is significantly associated with limb salvage.",
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