Patency of arterial repairs from wartime extremity vascular injuries

Background Extremity vascular injury (EVI) causes significant disability in Veterans of the Afghanistan/Iraq conflicts. Advancements in acute trauma care improved survival and decreased amputations. The study of wartime EVI has relied on successful limb salvage as a surrogate for vascular repair. We...

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Autores principales:	Lauren J Haney, Esther Bae, Mary Jo V Pugh, Laurel A Copeland, Chen-Pin Wang, Daniel J MacCarthy, Megan E Amuan, Paula K Shireman
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2020
Materias:	Surgery RD1-811 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/8317bc4f529a4c5db41126b2ba738be2
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spelling	oai:doaj.org-article:8317bc4f529a4c5db41126b2ba738be22021-11-11T09:30:06ZPatency of arterial repairs from wartime extremity vascular injuries10.1136/tsaco-2020-0006162397-5776https://doaj.org/article/8317bc4f529a4c5db41126b2ba738be22020-12-01T00:00:00Zhttps://tsaco.bmj.com/content/5/1/e000616.fullhttps://doaj.org/toc/2397-5776Background Extremity vascular injury (EVI) causes significant disability in Veterans of the Afghanistan/Iraq conflicts. Advancements in acute trauma care improved survival and decreased amputations. The study of wartime EVI has relied on successful limb salvage as a surrogate for vascular repair. We used imaging studies as a specific measure of arterial repair durability.Methods Service members with EVI were identified using the Department of Defense Trauma Registry and validated by chart abstraction. Inclusion criteria for the arterial patency subgroup included an initial repair attempt with subsequent imaging reports (duplex ultrasound, CT angiography, and angiogram) documenting initial patency.Results The cohort of 527 included 140 Veterans with available imaging studies for 143 arterial repairs; median follow-up from injury time to last available imaging study was 19 months (Q1–Q3: 3–58; range: 1–175). Injury mechanism was predominantly explosions (52%) and gunshot wounds (42%). Of the 143 arterial repairs, 81% were vein grafts. Eight repairs were occluded, replaced or included in extremity amputations. One upper extremity and three transtibial late amputations were performed for chronic pain and poor function averaging 27 months (SD: 4; range: 24–32). Kaplan-Meier analysis estimated patency rates of 99%, 97%, 95%, 91% and 91% at 3, 6, 12, 24, and 36 months, respectively, with similar results for upper and lower extremity repairs. Explosive and gunshot wound injury mechanisms had similar patency rates and upper extremity injuries repaired with vein grafts had increased patency.Conclusions Arterial repair mid-term patency in combat-related extremity injuries is excellent based on imaging studies for 143 repairs. Assertive attempts at acute limb salvage and vascular repair are justified with decisions for amputation versus limb salvage based on the overall condition of the patient and degree of concomitant nerve, orthopedic and soft tissue injuries rather than the presence of arterial injuries.Level of evidence Therapeutic/care management, level IV.Lauren J HaneyEsther BaeMary Jo V PughLaurel A CopelandChen-Pin WangDaniel J MacCarthyMegan E AmuanPaula K ShiremanBMJ Publishing GrouparticleSurgeryRD1-811Medical emergencies. Critical care. Intensive care. First aidRC86-88.9ENTrauma Surgery & Acute Care Open, Vol 5, Iss 1 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Surgery RD1-811 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Surgery RD1-811 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Lauren J Haney Esther Bae Mary Jo V Pugh Laurel A Copeland Chen-Pin Wang Daniel J MacCarthy Megan E Amuan Paula K Shireman Patency of arterial repairs from wartime extremity vascular injuries
description	Background Extremity vascular injury (EVI) causes significant disability in Veterans of the Afghanistan/Iraq conflicts. Advancements in acute trauma care improved survival and decreased amputations. The study of wartime EVI has relied on successful limb salvage as a surrogate for vascular repair. We used imaging studies as a specific measure of arterial repair durability.Methods Service members with EVI were identified using the Department of Defense Trauma Registry and validated by chart abstraction. Inclusion criteria for the arterial patency subgroup included an initial repair attempt with subsequent imaging reports (duplex ultrasound, CT angiography, and angiogram) documenting initial patency.Results The cohort of 527 included 140 Veterans with available imaging studies for 143 arterial repairs; median follow-up from injury time to last available imaging study was 19 months (Q1–Q3: 3–58; range: 1–175). Injury mechanism was predominantly explosions (52%) and gunshot wounds (42%). Of the 143 arterial repairs, 81% were vein grafts. Eight repairs were occluded, replaced or included in extremity amputations. One upper extremity and three transtibial late amputations were performed for chronic pain and poor function averaging 27 months (SD: 4; range: 24–32). Kaplan-Meier analysis estimated patency rates of 99%, 97%, 95%, 91% and 91% at 3, 6, 12, 24, and 36 months, respectively, with similar results for upper and lower extremity repairs. Explosive and gunshot wound injury mechanisms had similar patency rates and upper extremity injuries repaired with vein grafts had increased patency.Conclusions Arterial repair mid-term patency in combat-related extremity injuries is excellent based on imaging studies for 143 repairs. Assertive attempts at acute limb salvage and vascular repair are justified with decisions for amputation versus limb salvage based on the overall condition of the patient and degree of concomitant nerve, orthopedic and soft tissue injuries rather than the presence of arterial injuries.Level of evidence Therapeutic/care management, level IV.
format	article
author	Lauren J Haney Esther Bae Mary Jo V Pugh Laurel A Copeland Chen-Pin Wang Daniel J MacCarthy Megan E Amuan Paula K Shireman
author_facet	Lauren J Haney Esther Bae Mary Jo V Pugh Laurel A Copeland Chen-Pin Wang Daniel J MacCarthy Megan E Amuan Paula K Shireman
author_sort	Lauren J Haney
title	Patency of arterial repairs from wartime extremity vascular injuries
title_short	Patency of arterial repairs from wartime extremity vascular injuries
title_full	Patency of arterial repairs from wartime extremity vascular injuries
title_fullStr	Patency of arterial repairs from wartime extremity vascular injuries
title_full_unstemmed	Patency of arterial repairs from wartime extremity vascular injuries
title_sort	patency of arterial repairs from wartime extremity vascular injuries
publisher	BMJ Publishing Group
publishDate	2020
url	https://doaj.org/article/8317bc4f529a4c5db41126b2ba738be2
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Patency of arterial repairs from wartime extremity vascular injuries

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