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Published on: May 14, 2013
Outcomes of Arterial Grafts for the Reconstruction of Military Lower Extremity Arterial Injuries
Robert B Laverty1, Samantha G Brock2, Thomas J Walters3
1Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas.
Insights
Graft complications are common in lower extremity bypasses for combat casualties but do not increase limb loss risk. Early graft thrombosis, however, is linked to amputation, highlighting the need for timely interventions to improve limb salvage rates.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Military Medicine
Background:
- Lower extremity arterial injuries are frequent in military casualties.
- Limb salvage is a primary objective in treating these injuries.
- Bypass grafts are the most common surgical reconstructions, yet their outcomes are underreported.
Purpose of the Study:
- To describe outcomes of lower extremity arterial bypass grafts in combat casualties.
- To determine the association between graft complications and limb loss.
Main Methods:
- Retrospective cohort study of Iraq/Afghanistan casualties (2004-2012) with lower extremity arterial injury.
- Analysis of bypass graft data including graft complications (GC) and limb amputation.
- Follow-up until amputation, death, or discharge.
Main Results:
- 222 grafts were analyzed; 26% experienced at least one graft complication.
- Graft complications were not associated with graft level but linked to synthetic conduits.
- Early graft thrombosis (within 48h) was associated with amputation (P=0.001).
Conclusions:
- Graft complications are common but not directly associated with limb loss in combat casualties.
- Early graft thrombosis is a significant predictor of amputation.
- Ensuring early graft patency is crucial for improving limb salvage.
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.
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