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

Single-center civilian series report up to a 20% primary amputation rate following lower-extremity vascular trauma (LEVT). We characterize nationwide incidence and risk factors for primary amputation after LEVT using the Trauma Quality Improvement Program (TQIP) registry, which contains index admission data for over 900 trauma centers in the United States.

The 2017-2021 American College of Surgeons TQIP was queried for adults with surgically managed isolated lower-extremity trauma with associated arterial injury. The primary endpoint was primary major amputation. Multivariate logistic regression was performed to identify patient- and center-related factors associated with primary amputation versus revascularization.

Of 7534 LEVT patients, 743 (9.9%) underwent primary major amputation. Primary amputees were less likely to be Black (23.7 versus 41.9%, P < 0.001) and more likely to be privately insured (47.9 versus 33.9%, P < 0.001). On multivariate logistic regression adjusted for age, race, and comorbidities, blunt mechanism (odds ratio (OR), 4.8; P value < 0.001), tibial arterial injury (OR, 2.3; P value < 0.001), and bony involvement (OR, 2.3; P value < 0.001) were independently associated with primary amputation. Femoral arterial injury (OR, 0.4; P value < 0.001), popliteal injury (OR, 0.3; P value <0.001), and female sex (OR, 0.7; P value < 0.001) were protective.

In the TQIP multicenter registry, patients with isolated operative LEVT had a 9.9% primary amputation rate. Interfacility transfer rates did not differ between treatment groups, suggesting that most procedures were performed at the index hospital admission. In centers where transfer for revascularization is possible, expedient vascular surgical evaluation is necessary to facilitate limb salvage in this high-risk subpopulation.