Outcomes of Arterial Grafts for the Reconstruction of Military Lower Extremity Arterial Injuries

Autor: Thomas J. Walters, Samantha G. Brock, David S. Kauvar, Robert B. Laverty
Rok vydání: 2021
Předmět:
medicine.medical_specialty
Time Factors
Databases
Factual
medicine.medical_treatment
Limb salvage
Arteriovenous fistula
030204 cardiovascular system & hematology
Risk Assessment
Amputation
Surgical
030218 nuclear medicine & medical imaging
Blood Vessel Prosthesis Implantation
03 medical and health sciences
Pseudoaneurysm
0302 clinical medicine
Risk Factors
medicine
Humans
Military Medicine
Iraq War
2003-2011
Vascular Patency
Retrospective Studies
Afghan Campaign 2001
business.industry
Graft Occlusion
Vascular
Thrombosis
Retrospective cohort study
Arteries
General Medicine
Vascular System Injuries
Limb Salvage
medicine.disease
United States
Blood Vessel Prosthesis
Surgery
Arterial grafts
Stenosis
Treatment Outcome
Lower Extremity
Amputation
Arteriovenous Fistula
Cardiology and Cardiovascular Medicine
business
Aneurysm
False
Zdroj: Annals of Vascular Surgery. 76:59-65
ISSN: 0890-5096
Popis: Introduction Lower extremity (LE) arterial injuries are common in military casualties and limb salvage is a primary goal. Bypass grafts are the most common reconstructions; however, their specific outcomes are largely unreported. We sought to describe the outcomes of LE arterial grafts among combat casualties and their association with limb loss. Methods Retrospective cohort study of 2004-2012 Iraq/Afghanistan casualties with LE arterial injury undergoing bypass graft from a database containing follow-up until amputation, death, or military discharge. Primary outcome was composite graft complications (GC-thrombosis, stenosis, pseudoaneurysm, blowout, and/or arteriovenous fistula). Results Two hundred and twenty-two grafts were included (99 femoral, 73 popliteal, 48 tibial). 56 (26%) had at least one GC; thrombosis was most common in femoral, stenosis most common in popliteal and tibial. GC was not associated with graft level but was associated with synthetic conduit (P = 0.01) and trended towards an association with multiple-level arterial injuries (P = 0.07). Four of eight (50%) synthetic grafts had amputations, all within 72h. Two of the eight synthetic grafts thrombosed, and both limbs were amputated. There were 52 total amputations. Amputation was performed in 13 (23%) of limbs with a GC and 24% of those without (P = 0.93) Overall, 24 (11%) of grafts thrombosed, 16 within 48h and 13 (25%) in limbs undergoing amputation (P = 0.001 for association of thrombosis with amputation). Conclusion GC are common among LE bypass grafts in combat casualties but are not associated with limb loss. Thrombosis is predominantly early and is associated with amputation. Closer attention to ensuring early patency may improve limb salvage.
Databáze: OpenAIRE
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