D. J. Keleny1, A. D. Person1, G. Mendoza-Barrera1, S. R. Brown1, D. Rigg1, M. Dale1, J. Dabestani1, D. K. Agrawal1, J. A. Asensio1 1Creighton University Medical Center,Trauma Surgery And Surgical Critical Care,Omaha, NE, USA
Introduction: Femoral vessel injuries are the most frequent vascular injuries seen at Trauma Centers accounting for 70% of all peripheral large blood vessel injuries treated in large volume hospitals. This makes it important to determine parameters contributory to morbidity and mortality with such injuries in an effort to optimize management and predict outcome. Our objective is to review the National Trauma Data Bank with respect to location of femoral vessel injuries with related mortality, to identify predictors of patient outcome, and to report the outcomes of these injuries based on the aforementioned predictive variables including mechanism of injury.
Methods: The National Trauma Data Bank was queried for pre-hospital and admission data for femoral vessel injuries. The primary outcome measured was survival. Statistical analysis included univariate and stepwise logistic regression.
Results: A total of 2,021 patients were identified with a total of 2,693 femoral vessel injuries from 1,466,887 patients in the National Trauma Data Bank. This is an incidence of 0.13%, with the number of survivors being 1,788 (89%). Mean age of patients was 34.1±17.34. The mean revised trauma score (RTS) for survivors was 7.2±1.67 ; for non-survivors 3.57±3.35. The mean GCS for survivors was 13±3.65 ; for non-survivors 6.59±5.11. The mean injury severity score (ISS) for survivors was 16.73±6.32 ; for non-survivors 28.0±13.88. Mechanism of injury was documented in 1,996 patients, with the majority due to penetrating injuries (1,419; 71%). The most commonly injured vessel was the superficial femoral artery (1,044; 39%). The next most commonly injured vessels were the femoral vein (817 ; 30%), the common femoral artery (645; 24%), and the femoral nerve (153; 5.7%). The highest mortality was 19%, in patients with injuries to the common femoral artery.
Conclusion: Although there is a relatively high survival rate for femoral vessel injuries, they incur high complication rates. Initial admission parameters correlate well with morbidity and mortality, including neurological status and hemodynamic stability. When comparing mortality rates by location of injury, common femoral vessel injuries had a significantly higher mortality rate although the most commonly injured vessel is by far the superficial femoral artery. Femoral vein injuries were also more lethal than superficial femoral artery injuries. These correlations should be looked to for optimization of management.
