Predictive Factors of Amputation in Infrainguinal Vascular Trauma: A Monocentric Experience

Abstract

Background: Infrainguinal vascular injuries (IIVIs) are emergencies involving both functional and vital prognosis. The choice between saving the limb or doing a first-line amputation is difficult even for an experienced surgeon. The aims of this work are to analyze early outcomes in our center and to identify predictive factors for amputation.

Methods: Between 2010 and 2017, we reviewed retrospectively patients with IIVI. The main criteria for judgment were as follows: primary, secondary, and overall amputation. Two groups of potential risk factors of amputation were analyzed: Those related to the patient: age, shock, ISS score and those related to the lesion: mechanism, above or below the knee, bone lesions, venous lesions and skin decay. A univariate and multivariate analysis were performed to determine the risk factor(s) independently associated with the occurrence of amputation.

Results: Fifty-seven IIVIs were found in 54 patients. The mean ISS was 32,3 ± 21. A primary amputation was performed in 19%, and secondary in 14% of cases. Overall amputation rate was 35% (n = 19). Multivariate analysis reveals that the ISS is the only predictor of primary (P = 0.009; odds ratio (OR):1.07; confidence interval (CI):1.01-1.12) and global (P = 0.04; OR:1.07; IC:1.02-1.13) amputation. A threshold value of 41 was selected as a primary amputation risk factor with a negative predictive value of 97%.

Conclusions: The ISS is a good predictor of the risk of amputation in IIVI. A threshold of 41 is an objective criterion helping to decide for a first-line amputation. Advanced age and hemodynamic instability should not be important in the decision tree.