Arterial injuries of the lower extremity from blunt trauma

Thirty patients with 33 arterial injuries from blunt trauma of the lower extremity at Chulalongkorn Hospital, Bangkok, Thailand from January 1989 to December 1995 were reviewed. Eight patients (26.6%) were in shock on arrival. Twenty four (80%) presented with signs of ischemia. Twenty six (86.7%) had associated fractures and/or dislocations, 14 of them were compound fractures. Nine (30%) had associated injuries at other parts of the body. Ten (33.3%) underwent preoperative angiography. The preoperative time ranged from 1 to 72 hours, median 4 hours. One patient who had intimal tear of the popliteal artery and was successfully treated conservatively. Popliteal artery was the most common injured artery; followed by common femoral, superficial femoral, and anterior tibial artery. Most arterial injuries were repaired by using reversed saphenous vein grafts. Associated venous injuries were repaired in 5 patients. Fracture fixation was performed in 18 patients; 8 of them were performed before arterial repair and 10 were performed after arterial repair. No intravascular shunt was inserted in this study. Fasciotomy was performed in 15 patients. Five patients had limb amputation (16.7%). Univariate analysis by Chi Square test revealed that associated venous injuries, severe soft tissue injuries, and fasciotomy were statistically significant factors associated with amputation. One patient who had external iliac artery injury died from severe head injury in spite of a successful arterial repair (mortality rate 3.3%).