OBJECTIVES: Lower extremity vascular trauma (LEVT) is a major cause of limb loss. An understanding of prognostic factors for amputation following LEVT repair is essential to inform surgical decision-making, patient counselling and risk stratification. However, evidence for many factors is weak and often conflicting. The objective of this systematic review was to develop a contemporary and accurate understanding of prognostic factors for amputation following surgical repair of LEVT. METHODS: We performed a systematic review according to PRISMA guidelines. MEDLINE, EMBASE and CINAHL databases were searched between January 2000 and July 2012 for observational studies describing LEVT surgical repair outcomes. The primary outcome was amputation. Patient, injury and treatment factors associated with amputation were identified. Unadjusted proportions, odds ratios and risk differences, for all identified prognostic factors, were pooled using Bayesian random-effects meta-analysis models. RESULTS: Forty-five articles, totalling 3168 discrete LEVT repairs were included. The overall amputation incidence was 11.6%. Significant prognostic factors for secondary amputation include: gender (male 7% vs. female 12%; OR 0.41), Mechanism of Injury (Blast 19%, Blunt 16%, Penetrating 5%), anatomical site of injury (Iliac 18%, Popliteal 14%, Tibial 9%, Femoral 4%), associated fracture (14% vs. 2%; OR 4.3), major soft tissue injury (28% vs. 9%; OR 6.5), ischaemic time > 6 hours (24% vs. 5%; OR 4.4) and development of compartment syndrome (31% vs. 6%; OR 6.4). Age, associated nerve or venous injuries and shock were not significant prognostic factors for secondary amputation. CONCLUSIONS: A small but important proportion of patients who undergo emergency repair of LEVT will require secondary amputation. The prognostic factors described and the underlying evidence base will facilitate considered surgical judgement, improved risk assessment and informed patient counselling during the post-operative period.
Perkins, Z. B., Yet, B., Glasgow, S., Marsh, W., Brohi, K., Rasmussen, T. E., & Tai, N. R. (2014). PS170. Prognostic Factors for Amputation Following Surgical Repair of Lower Extremity Vascular Trauma: A Systematic Review and Meta-Analysis of Observational Studies. Journal of Vascular Surgery, 59(6), 75S. https://doi.org/10.1016/j.jvs.2014.03.167