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- W4385478824 abstract "Background Expeditious revascularization is key to limb salvage after arterial injuries, but the relationship between time to revascularization and amputation risk is not well-defined. We aimed to explore amputation risk based on time to revascularization in a cohort of military femoropopliteal arterial injuries. Methods A database of vascular injuries from Iraq and Afghanistan casualties (2004-2012) was queried for femoral (common, superficial, or deep) and/or popliteal arterial injuries that underwent revascularization. Time from injury to initial revascularization (via shunt or reconstruction) was divided into groups of < 3h, 3-6h, 6-9h, and > 9h and bivariate comparisons were performed. Results Revascularization times were available for 120 cases. Injury and treatment characteristics by time group were generally similar between time groups. Shunting and vein injuries were more common in limbs revascularized earlier, while blast mechanism and fasciotomy were more common with later revascularization. Ten (8%) cases underwent revascularization in less than 3 hours, 63 (53%) were revascularized in 3-6 hours, 33 (28%) in 6-9 hours, and 14 (12%) after 9 hours. Amputation rates within the cohorts were 10%, 21%, 24%, and 50%, respectively (P=0.085, Figure 1). (P=0.085, chi square of amputation rates across time groups). The mean ± SD revascularization time for amputated limbs was 442 ± 348 min vs 347 ± 183 min for salvaged limbs (P=0.057). Amputation was performed in 19% of limbs revascularized in < 6h and in 32% revascularized > 6h from injury (P=0.112). The > 9h group, however, had a 50% amputation rate vs 21% for those with revascularization in <9h. (P=0.016). Fractures were more common in > 9h limbs than < 9h (79% vs 44%, P=0.016), but other limb injury characteristics were similar, with no difference in limb injury severity scores. Among 91 salvaged limbs, neither vascular nor other complications were predicted by time to revascularization. All seven > 9h limbs had a limb complication, most commonly infection (71%), and three (42%) required a skin graft to close their fasciotomies. Conclusions Increasing time from injury to initial revascularization was associated with increasing rates of limb loss. Revascularization within 3 hours of injury resulted in a low amputation rate, while half of limbs treated after 9 hours were amputated. Arterial shunting was associated with earlier revascularization and should be considered a mainstay of combat casualty vascular care. Forward deployed surgical assets play a pivotal role in providing early revascularization and reducing rates of limb loss in modern combat casualty care." @default.
- W4385478824 created "2023-08-03" @default.
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- W4385478824 date "2023-08-01" @default.
- W4385478824 modified "2023-09-27" @default.
- W4385478824 title "Association between time to revascularization and limb loss in military femoropopliteal arterial injuries" @default.
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- W4385478824 doi "https://doi.org/10.1016/j.jvs.2023.07.055" @default.
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