Blunt Tibial Injury Is Associated With Primary Amputation for Lower Extremity Vascular Trauma

Area of Science:

• Vascular Surgery
• Trauma Surgery
• Epidemiology

Background:

• Lower-extremity vascular trauma (LEVT) presents a significant challenge, with previous single-center studies reporting up to a 20% primary amputation rate.
• Understanding nationwide incidence and risk factors is crucial for improving patient outcomes.

Purpose of the Study:

• To characterize the national incidence of primary amputation following LEVT.
• To identify patient- and center-related risk factors associated with primary amputation versus revascularization.

Main Methods:

• Analysis of the 2017-2021 American College of Surgeons Trauma Quality Improvement Program (TQIP) registry.
• Inclusion of adult patients with surgically managed isolated lower-extremity trauma and arterial injury.
• Multivariate logistic regression to identify factors associated with primary major amputation.

Main Results:

• A total of 7534 LEVT patients were analyzed, with 9.9% undergoing primary major amputation.
• Blunt mechanism (OR, 4.8), tibial arterial injury (OR, 2.3), and bony involvement (OR, 2.3) were independently associated with primary amputation.
• Femoral arterial injury (OR, 0.4), popliteal injury (OR, 0.3), and female sex (OR, 0.7) were found to be protective against amputation.

Conclusions:

• The TQIP registry data indicate a 9.9% primary amputation rate for isolated operative LEVT.
• Most procedures were performed at the index hospital, as interfacility transfer rates did not differ significantly.
• Expedient vascular surgical evaluation is critical for limb salvage in high-risk LEVT patients, especially where revascularization transfer is possible.