Impact of Ischemia Duration on Lower Limb Salvage in Combat Casualties.

Autor:	Perkins ZB; Centre for Trauma Sciences, Queen Mary University of London, London, UK., Kersey AJ; Battlefield Shock and Organ Support Laboratory, Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD.; Walter Reed National Military Medical Center, Bethesda, MD., White JM; Battlefield Shock and Organ Support Laboratory, Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD.; Walter Reed National Military Medical Center, Bethesda, MD., Lauria AL; Battlefield Shock and Organ Support Laboratory, Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD.; Walter Reed National Military Medical Center, Bethesda, MD., Propper BW; Walter Reed National Military Medical Center, Bethesda, MD., Tai NRM; Centre for Trauma Sciences, Queen Mary University of London, London, UK.; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK., Rasmussen TE; Centre for Trauma Sciences, Queen Mary University of London, London, UK.; Mayo Clinic, Rochester, MN.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2022 Sep 01; Vol. 276 (3), pp. 532-538. Date of Electronic Publication: 2022 Jun 27.
DOI:	10.1097/SLA.0000000000005560
Abstrakt:	Introduction: The 6-hour threshold to revascularization of an ischemic limb is ubiquitous in the trauma literature, however, contemporary evidence suggests that this threshold should be less. This study aims to characterize the relationship between the duration of limb ischemia and successful limb salvage following lower extremity arterial trauma. Methods: This is a cohort study of the United States and UK military service members injured while serving in Iraq or Afghanistan between 2003 and 2013. Consecutive patients who sustained iliac, femoral, or popliteal artery injuries, and underwent surgery to attempt revascularization, were included. The association between limb outcome and the duration of limb ischemia was assessed using the Kaplan-Meier method. Results: One hundred twenty-two patients (129 limbs) who sustained iliac (2.3%), femoral (56.6%), and popliteal (41.1%) arterial injuries were included. Overall, 87 limbs (67.4%) were successfully salvaged. The probability of limb salvage was 86.0% when ischemia was ≤1 hour; 68.3% when between 1 and 3 hours; 56.3% when between 3 and 6 hours; and 6.7% when >6 hours ( P <0.0001). Shock more than doubled the risk of failed limb salvage [hazard ratio=2.42 (95% confidence interval: 1.27-4.62)]. Conclusions: Limb salvage is critically dependent on the duration of ischemia with a 10% reduction in the probability of successful limb salvage for every hour delay to revascularization. The presence of shock significantly worsens this relationship. Military trauma systems should prioritize rapid hemorrhage control and early limb revascularization within 1 hour of injury. Competing Interests: The authors report no conflicts of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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