Blunt vascular XXXX in the extremity: diagnosis, management, and outcome.

@entity1 @entity174 @entity245 @entity5925 @entity1230 @entity1317 @entity291 @entity130
BACKGROUND: Blunt vascular @entity130 in an extremity is an uncommon diagnosis. Considering the complexity of these injuries, it is worthwhile to determine how select factors affect the outcome of the limb and the @entity1 . The objectives of this study were to review the diagnosis, management, and outcomes of @entity1 who sustained blunt @entity1317 in the extremities and relate factors in their treatment to the outcome of the injured extremity. METHODS: A retrospective review of data on adult and pediatric @entity1 who had a diagnosis of blunt @entity1317 in an extremity and underwent some attempt at restoration of vascular flow was conducted. RESULTS: From January 1995 to December 2002, 62 @entity1 (80.3% male; mean age, 33.2 +/- 15.8 years) sustained blunt @entity130 (mean Injury Severity Score, 14.6 +/- 8.4), with 93 @entity1317 in 65 extremities (16 upper and 49 lower). Hard signs of @entity1317 occurred in 41 (66%) @entity1 . An associated @entity174 and/or dislocation was present in 59 @entity1 (95%). Preoperative arteriograms were obtained in 20 @entity1 (17 occlusions, 2 embolizations, and 1 untreated). @entity130 were as follows: 16 upper (brachial artery, 50%) and 63 lower (tibial/peroneal/popliteal, 84%), with ligation being the most common treatment in the latter. Intravascular shunts were used to restore blood flow in 18 vessels (13 arteries and 5 veins) in 13 @entity1 . Delays in diagnosis or treatment occurred in six @entity1 , mostly because of errors in management/judgment. @entity245 were performed in six @entity1 , and five developed @entity5925 . Six @entity1 died. The age (p = 0.0006), Injury Severity Score (p = 0.0007), and Mangled Extremity Severity Score (p = 0.0009) were significantly different for the survivors compared with the nonsurvivors. CONCLUSION: Blunt @entity1317 in the lower extremities occur most commonly in the anteroposterior tibial arteries; injured arteries in the proximal upper and lower extremity require resection with interposition grafting, whereas those in the forearm or @entity291 are usually ligated; the amputation rate in 65 injured extremities with blunt vascular @entity130 was 18.%, which is at least three times that for those who sustain penetrating injury; and delays in diagnosis and treatment are uncommon in these @entity1 with @entity1230 .
