Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202300501
Jornal Vascular Brasileiro
Original Article

Fatores prognósticos em traumatismos vasculares do segmento femoropoplíteo: decisões intraoperatórias são importantes

Prognostic factors for femoropopliteal vascular injuries: surgical decisions matter

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

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Resumo

Contexto: O trauma vascular acomete frequentemente os membros inferiores; entretanto, ainda há dúvidas sobre quais fatores levam a desfechos desfavoráveis.

Objetivos: Determinar o perfil das vítimas de traumatismo femoropoplíteo, o tratamento utilizado e fatores relacionados a desfechos desfavoráveis.

Métodos: Estudo retrospectivo, baseado em prontuários de pacientes operados entre 2017 e 2021. Foram analisados: sexo, idade, distância percorrida para atendimento, mecanismo de trauma, presença de choque hipovolêmico, lesões associadas, tratamento, realização de fasciotomia, decisões intraoperatórias inadequadas e índice de severidade de trauma. Necessidade de reintervenção, amputação e óbito foram considerados desfechos desfavoráveis. Foram utilizadas análises univariadas, bivariadas e regressão logística.

Resultados: Noventa e quatro pacientes foram selecionados, sendo 83% homens, com idade média de 30,8 anos. Lesões arteriais e venosas simultâneas ocorreram em 57,5% dos casos; vasos femorais superficiais foram mais acometidos (61,7%), e mecanismos penetrantes, mais prevalentes (80,9%). Lesões arteriais foram frequentemente tratadas com enxerto venoso (59,6%), e lesões venosas foram submetidas à ligadura (81,4%). Em 15% houve decisões cirúrgicas inadequadas, sendo o uso da safena magna ipsilateral para reconstrução arterial a mais comum. Ocorreram desfechos desfavoráveis em 44,7% dos casos; em 21,3%, foi necessária reintervenção; amputação em 25,5%; e ocorreu óbito em 9,5% dos pacientes.

Conclusões: As lesões acometeram principalmente homens jovens, vítimas de ferimento por arma de fogo. Vasos femorais superficiais foram os mais lesados, e traumatismos não vasculares concomitantes foram frequentes, principalmente fraturas. Decisões cirúrgicas inadequadas aumentaram em 34 vezes a necessidade de reintervenções. Necessidade de realização de fasciotomia, presença de fratura/luxação, mecanismo contuso de trauma e lesão de artéria poplítea aumentaram o risco de amputação.

Palavras-chave

lesões do sistema vascular, membros inferiores, procedimentos cirúrgicos vasculares, prognóstico

Abstract

Background: Lower limbs are frequently involved in vascular trauma, but it is still not clear which factors lead to unfavorable clinical outcomes.

Objectives: To determine the clinical profile of patients with femoropopliteal injuries, the trauma mechanisms, and treatment and identify which factors led to unfavorable outcomes.

Methods: A retrospective study based on the medical records of patients treated from 2017 to 2021. The following data were assessed: sex, age, distance to reach the hospital, trauma mechanism, hypovolemic shock, additional injuries, treatment of vascular injuries, whether fasciotomy was needed, inappropriate intraoperative decisions, and injury severity score. Need for surgical reintervention, amputation, and death were defined as unfavorable outcomes. Univariate, bivariate, and logistic regression analyses were conducted.

Results: The sample comprised 94 patients; 83% were men; mean age was 30.8 years; combined arterial and venous injuries prevailed (57.5%); and superficial femoral vessels were the most affected (61.7%). Penetrating mechanisms prevailed (80.9%). Arterial injuries were most frequently treated with venous graft (59.6%) and venous injuries underwent ligation (81.4%). In 15% of cases, inappropriate surgical decisions were detected; most often use of the ipsilateral great saphenous vein for arterial reconstruction. Unfavorable outcomes occurred in 44.7%: surgical reintervention was necessary in 21.3% and limb amputation in 25.5%, while 9.5% of the patients died.

Conclusions: These injuries mainly involved young men, victims of gunshot wounds. Superficial femoral vessels were the most injured; concomitant non-vascular trauma was frequent, mainly fractures. Inappropriate surgical decisions increased the need for reinterventions by 34 times. Need for fasciotomy, presence of fracture/dislocation, blunt trauma mechanism, and popliteal artery injury increased the risk of amputation.

Keywords

vascular system injuries; lower extremities; vascular surgical procedures; prognosis

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Submitted date:
05/09/2023

Accepted date:
08/04/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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