Prognostic factors for femoropopliteal vascular injuries: surgical decisions matter

Góes Junior, Adenauer Marinho de Oliveira; Albuquerque, Fernanda Beatriz Araújo de; Feijó, Matheus Oliveira; Albuquerque, Flávia Beatriz Araújo de; Corrêa, Luciana Roberta do Vale; Andrade, Mariseth Carvalho de

doi:10.1590/1677-5449.202300502

Adenauer Marinho de Oliveira Góes Junior

conception and design

analysis and interpretation

data collection

writing the article

critical revision of the article

statistical analysis

Universidade Federal do Pará - UFPA, Belém, PA, Brasil.

https://orcid.org/0000-0001-9345-9539

Fernanda Beatriz Araújo de Albuquerque

conception and design

analysis and interpretation

data collection

writing the article

critical revision of the article

Universidade Federal do Paraná - UFPR, Hospital das Clinicas - HC, Curitiba, PR, Brasil.

Matheus Oliveira Feijó

conception and design

analysis and interpretation

data collection

writing the article

critical revision of the article

Força Aérea Brasileira - FAB, Belém, PA, Brasil.

Flávia Beatriz Araújo de Albuquerque

analysis and interpretation

writing the article

critical revision of the article

Exército Brasileiro - EB, Macapá, AP, Brasil.

https://orcid.org/0000-0003-4401-3893

Luciana Roberta do Vale Corrêa

analysis and interpretation

data collection

writing the article

critical revision of the article

Hospital Metropolitano de Urgência e Emergência - HMUE, Ananindeua, PA, Brasil.

Mariseth Carvalho de Andrade

analysis and interpretation

writing the article

critical revision of the article

statistical analysis

Fundação Santa Casa de Misericórdia do Pará - FSCMPA, Belém, PA, Brasil.

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Ethics committee approval: CAAE 2114919.8.0000.5169, report 492877.

Correspondence Adenauer Marinho de Oliveira Góes Junior Universidade Federal do Pará - UFPA Rua Domingos Marreiros, 307, apto. 802 - Umarizal CEP 66055-210 - Belém (PA), Brasil Tel.: +55 (91) 98127-9656 E-mail: adenauerjunior@gmail.com

Author information AMOGJ - Vascular surgeon; Full member, Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV); Board certified in Angiorradiologia and Cirurgia Endovascular; PhD, Programa de Pós-graduação em Ciências Cirúrgicas Interdisciplinares (UNIFESP-EPM); Professor of Cirurgia, Faculdade de Medicina, Universidade Federal do Pará (UFPA). FBAA - MD certified by Conselho Regional de Medicina do Estado do Paraná; Ginecologia e Obstetrícia residente, Hospital das Clínicas, Universidade Federal do Paraná (HC - UFPR). MOF - MD certified by Conselho Regional de Medicina do Estado do Pará; Trainee, Força Aérea Brasileira (FAB). FBAA - MD certified by Conselho Regional de Medicina do Estado do Amapá; 1º lieutenant, Exército Brasileiro (EB). LRVC - MD certified by Conselho Regional de Medicina do Estado do Pará; Cirurgia Geral resident, Hospital Metropolitano de Urgência e Emergência (HMUE). MCA - Statistician; Epidemiologista; MSc in Cirurgia e Pesquisa Experimental, Fundação Santa Casa de Misericórdia do Pará (FSCMPA).

Variables	N	%	p-value
Sex			< 0.0001*
Female	16	17.0%
Male*	78	83.0%
Age group			< 0.0001*
< 30*	51	54.3%
30 to 39	24	25.5%
> = 40	19	20.2%
Minimum/mean/maximum	16 / 30.8 / 70 years
Distance (km)			0.9156
Up to 100^* * Chi-square test of adherence;	45	47.9%
More than 100	44	46.8%
Not recorded	5	5.3%
Additional injuries			0.3023
Present	52	55.3%
Absent	42	44.7%
Injured structure	52\|\|	55.3%	0.0055 ^† † G test of adherence; N: number of cases; %: percentage of cases;
Appendicular skeleton*^‡ ‡ Fracture: calcaneus (1), tibia (15), fibula (2), femur (20), carpal (1), radius (3), ulna (2), humerus (2); luxations were detected of the: knee (5) and hips (2);	36^¶ ¶ Some patients had injuries to more than one appendicular skeleton structure.	69.2%
Other vascular injuries^§ § other vascular injuries: deep femoral artery (4), anterior tibial artery (2), pudendal vessels (1), tibioperoneal trunk (2), external iliac vein (1), deep femoral vein (1), genicular artery (1);	13	25.0%
Abdomen/pelvis	9	17.3%
Thorax	3	5.8%
Head/neck	1	1.9%

Variables	N	%	p-value
Injured vascular structures			< 0.0001*
Artery and vein*	54	57.5%
Artery only	35	37.2%
Vein only	5	5.3%
Injured vessels
Superficial femoral vessels^* * Chi-square test of adherence; N: number of cases; %: percentage of cases;	58	61.7%	0.0233*
Popliteal vessels	31	33.0%
Common femoral vessels	14	14.9%
Injured arteries*	89 ^† † N is the number of patients who had at least one injury to one of the arteries or veins being studied; there were patients who had more than one of the arterial/venous injuries studied.	94.7%	< 0.0001*
Superficial femoral*	56	62.9%	0.0197*
Popliteal	27	30.3%
Common femoral	10	11.2%
Injured veins*	59^†	62.8%	0.0039*
Superficial femoral*	31	52.5%	0.0013*
Popliteal	24	40.7%
Common femoral	8	13.6%

Variables	N	%	p-value
Trauma mechanism			< 0.0001*
Penetrating*	76	80.9%
Gunshot	70	92.1%
Knife wound	6	7.9%
Blunt	18	19.1%
Traffic accidents	18	100.0%
Description of arterial injury	89 ^† † N is the number of patients who had at least one injury to one of the arteries or veins being studied; there were patients who had more than one of the arterial/venous injuries studied.		< 0.0001*
Partial/total section*	47	52.8%
Thrombosis	16	18.0%
Pseudoaneurysm	7	7.9%
Arteriovenous fistula	6	6.7%
Not recorded	18	20.2%
Arterial treatment			< 0.0001*
Venous graft*	53	59.6%
End-to-end anastomosis	21	23.6%
Fogarty thrombectomy	5	5.6%
Ligation	4	4.5%
Arteriorrhaphy	3	3.4%
Prosthetic graft	1	1.1%
Patch	1	1.1%
Arterial shunt	1	1.1%
Description of venous injury	59^†		< 0.0001*
Partial/total section^* * G test of adherence; N: number of cases; %: percentage of cases;	29	49.2%
Arteriovenous fistula	6	10.2%
Thrombosis	1	1.7%
Not recorded	23	39.0%
Venous treatment			< 0.0001*
Ligation*	48	81.4%
Venorrhaphy	8	13.6%
Anticoagulation	1	1.7%
Not recorded	2	3.4%

Variables	N	%	p-value
Inappropriate surgical decisions			< 0.0001 ^* * G test of adherence; N: number of cases; %: percentage of cases.
Present	15	16.0%
Absent*	79	84.0%
Unfavorable outcome			0.1891
Yes	42	44.7%
No	52	55.3%
Type of unfavorable outcome*			0.5465
Amputation	24	25.5%
Reintervention	20	21.3%
Death	9	9,60%
Combinations of unfavorable outcomes	42		0.0255*
Amputation only*	16	38.1%
Reintervention only	10	23.8%
Death only	5	11.9%
Amputation + reintervention	7	16.7%
Reintervention + death	3	7.1%
Amputation + death	1	2.4%

Variables	N	Surgical reintervention
Variables	N	Yes (n=20)		No (n=74)		p-value
Superficial femoral vessels (n=58)						0.1681
Artery and vein	32	8	25.0%	24	75.0%
Artery only	24	2	8.3%	22	91.7%
Vein only	2	0	0.0%	2	100.0%
Popliteal vessels (n=31)						0.2593
Artery and vein	21	8	38.1%	13	61.9%
Artery only	7	2	28.6%	5	71.4%
Vein only	3	0	0.0%	3	100.0%
Common femoral vessels (n=14)						0.4069
Artery and vein	6	1	16.7%	5	83.3%
Artery only	6	0	0.0%	6	100.0%
Vein only	2	0	0.0%	2	100.0%
Needed fasciotomy						0.1571
Yes	30	9	30.0%	21	70.0%
No	64	11	17.2%	53	82.8%
Fracture and/or luxation						0.3543
Yes	34	9	26.5%	25	73.5%
No	60	11	18.3%	49	81.7%
Trauma mechanism						0.9554
Gunshot	70	15	21.4%	55	78.6%
Traffic accident	18	4	22.2%	14	77.8%
Knife wound	6	1	16.7%	5	83.3%
Shock at admission						0.7521
Yes	35	15	42.9%	20	57.1%
No	59	22	37.3%	37	62.7%
Arterial treatment						0.9858
Venous graft	53	10	18.9%	43	81.1%
End-to-end anastomosis	21	4	19.0%	17	81.0%
Venous treatment						0.3479
Ligation	48	13	27.1%	35	72.9%
Venorrhaphy	8	1	12.5%	7	87.5%
Inappropriate surgical decision						0.0001 ^* * G test of independence; N: number of cases; %: percentage of cases.
Present	15	14	93.3%	1	6.7%
Absent	79	23	29.1%	56	70.9%

Variables	N	Amputation
Variables	N	Yes (n=24)		No (n=70)		p-value
Superficial femoral (n=58)						0.8270
Artery and vein	32	2	6.3%	30	93.8%
Artery only	24	2	8.3%	22	91.7%
Vein only	2	0	0.0%	2	100.0%
Popliteal (n=31)						0.0334*
Artery and vein	21	14	66.7%	7	33.3%
Artery only	7	7	100.0%	0	0.0%
Vein only	3	1	33.3%	2	66.7%
Common femoral (n=14)						0.4069
Artery and vein	6	1	16.7%	5	83.3%
Artery only	6	0	0.0%	6	100.0%
Vein only	2	0	0.0%	2	100.0%
Needed fasciotomy						< 0.0001*
Yes	30	16	53.3%	14	46.7%
No	64	8	12.5%	56	87.5%
Fracture and/or luxation						0.0003*
Yes	34	16	47.1%	18	52.9%
No	60	8	13.3%	52	86.7%
Trauma mechanism						0.0002 ^* * G test of independence; N: number of cases; %: percentage of cases.
Gunshot	70	11	15.7%	59	84.3%
Traffic accident	18	12	66.7%	6	33.3%
Knife wound	6	1	16.7%	5	83.3%
Shock at admission						0.7826
Yes	35	10	28.6%	25	71.4%
No	59	14	23.7%	45	76.3%
Arterial treatment						0.4981
Venous graft	53	14	26.4%	39	73.6%
End-to-end anastomosis	21	4	19.0%	17	81.0%
Venous treatment						0.0194*
Ligation	48	15	31.3%	33	68.8%
Venorrhaphy	8	0	0.0%	8	100.0%
Inappropriate surgical decision						0.0110*
Present	15	8	53.3%	7	46.7%
Absent	79	16	20.3%	63	79.7%

Variables	N	Amputation
Variables	N	Yes (n=24)		No (n=70)		p-value
Superficial femoral vein (n=31)						0.5080
With venous ligation	25	1	4.0%	24	96.0%
Without venous ligation	6	0	0.0%	6	100.0%
Popliteal vein (n=24)						0.0930
With venous ligation	20	14	70.0%	6	30.0%
Without venous ligation	4	1	25.0%	3	75.0%
Common femoral vein (n=08)						0.0712
With venous ligation	6	0	0.0%	6	100.0%
Without venous ligation	2	1	50.0%	1	50.0%

Variables	N	Outcome of treatment
Variables	N	Survival (n=85)		Death (n=09)		p-value
Superficial femoral (n=58)						0.5442
Artery and vein	32	27	84.4%	5	15.6%
Artery only	24	22	91.7%	2	8.3%
Vein only	2	2	100.0%	0	0.0%
Popliteal (n=31)						0.0814
Artery and vein	21	21	100.0%	0	0.0%
Artery only	7	7	100.0%	0	0.0%
Vein only	3	2	66.7%	1	33.3%
Common femoral (n=14)						0.1717
Artery and vein	6	4	66.7%	2	33.3%
Artery only	6	6	100.0%	0	0.0%
Vein only	2	2	100.0%	0	0.0%
Needed fasciotomy						0.4993
Yes	30	28	93.3%	2	6.7%
No	64	57	89.1%	7	10.9%
Fracture and/or luxation						0.5132
Yes	34	30	88.2%	4	11.8%
No	60	55	91.7%	5	8.3%
Trauma mechanism						0.1198
Gunshot	70	65	92.9%	5	7.1%
Traffic accident	18	14	77.8%	4	22.2%
Knife wound	6	6	100.0%	0	0.0%
Shock at admission						0.2404
Yes	35	30	85.7%	5	14.3%
No	59	55	93.2%	4	6.8%
Arterial treatment						0.3556
Venous graft	53	47	88.7%	6	11.3%
End-to-end anastomosis	21	20	95.2%	1	4.8%
Venous treatment						0.1278
Ligation	48	41	85.4%	7	14.6%
Venorrhaphy	8	8	100.0%	0	0.0%
Inappropriate surgical decision						0.6632
Present	15	1	6.7%	14	93.3%
Absent	79	8	10.1%	71	89.9%

[1] Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Brasil

Brasil

Prognostic factors for femoropopliteal vascular injuries: surgical decisions matter

Abstract

Background

Objectives

Methods

Results

Conclusions