The Increasing Rate of Secondary Amputation in Popliteal Arterial Injury Associated with Multi-Organ Injuries and Hypotension

Obejectives: To study the role of hypotension and associated injuries in increasing the
chances of secondary amputation in lower limb with vascular injuries.
Methods: This study was conducted in the Department of cardiovascular and thoracic
surgery( CVTS ), Sher-i- Kashmir Institute of Medical Sciences, ( SKIMS ) Srinagar
Kashmir India and comprised all patients sustaining vascular injury due to different
causes like road traffic accident, fire arm and blast injuries or falling from height during
the last five years. Following admission to our Department, the patients were divided into
two groups. The first group with associated injuries was hemodynamically unstable during
vascular repair or in post-operative period and the second group had no associated injuries
and was hemodynamically stable during vascular repair and in post-operative period.
Results: During the past five years, 95 patients were operated for lower limb vascular
injury in our department. Of these 25 patients had associated multi-organ injuries and
were hemodynamically unstable and needed intensive care monitoring after surgical
intervention. Additionally, 10 patients died due to associated multiple organ injuries, 10
needed amputation due to recurrent thrombosis of their anastomosis, and in five patients
limb salvage was achieved. Seventy patients who had isolated limb vascular injuries with
no associated injuries or hypotension were hemodynamically stable and were kept in
low dependency unit after vascular repair. Only Four patients from this group needed
amputation for thrombosis of the anastomosis.
Conculsion: Patients with shock and related injuries face significant rate of amputation.
These patients whether with multi-organ injuries or isolated vascular injuries need
judicious treatment for hypovolumic shock during surgical intervention and in postoperative
period.