Predictive Factors of Amputation for Post-Bypass Surgery on Vascular Trauma Patients

Afila Reza Kusworo, Heroe Soebroto, Heri Suroto

Abstract


n Indonesia, most vascular trauma is linked to traffic collisions. According to the Statistics Indonesia (Badan Pusat Statistik, BPS), there were 116,411 accidents in 2019. Limb salvages become important in  vascular trauma, which is performed through, among others, vascular bypass surgery. However, secondary amputation still occurs after vascular bypass. This study aimed to determine the predictors of secondary amputation after vascular bypass due to vascular trauma. This study used descriptive analysis of medical records and univariate analysis. Medical records of patients with vascular trauma underwent vascular bypass in Dr Soetomo Regional Hospital, Indonesia, from January 2018 to December 2020 were collected. Independent variables were age, MESS, time interval between the incident of trauma to the first incision of bypass surgery, penetrating and blunt injury, injured arterial segment, multiple injuries, and obesity. The dependent variable was secondary amputation. Fisher Exact Test was used to analyze the correlation between dependent and independent variables. Results showed a significant difference between patients with a MESS score of >7 and those with a MESS score of  ≤7 (p=0.044), where more patients with a MESS score of >7 experienced secondary amputation. Other variables showed no significant difference (p>0.05). This study concluded that MESS could be used as a predictor of secondary amputation in vascular trauma after vascular bypass. Further studies using multivariate analysis and a larger sample need to be conducted to get further insights on this phenomenon.


Keywords


Bypass surgery, MESS, predictor, traffic accident, vascular trauma, vascular bypass surgery

Full Text:

PDF

References


  1. BPS. Badan Pusat Statistik. Jumlah Kecelakaan, Korban Mati, Luka Berat, Luka Ringan, dan Kerugian Materi, 2020. Statistik Indonesia 2020. Jakarta: Statistical Yearbook Indonesia; 2020.
  2. Huber GH, Manna B. Vascular Extremity Trauma. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
  3. Suhardi. Tatalaksana Trauma Vascular. In: Aceh Surgery Update 2; 2017.
  4. Gaudino M, Antoniades C, Benedetto U, Deb S, Franco DA, Giammarco DG, et al. Mechanisms, consequences, and prevention of coronary graft failure. Circulation. 2017;136(18):1749–64. doi:10.1161/CIRCULATIONAHA.117.027597
  5. abbani S, Azam Haseen M, Ali Rizwi A, Hanif Beg M. Can mangled extremity scoring system (MESS) solve the mess of vascular trauma. 2020;7(1):22–8 DOI: 10.4103/ijves.ijves_44_19
  6. Ray HM, Sandhu HK, Meyer DE, Miller CC, Vowels TJ, Afifi RO, et al. Predictors of poor outcome in infrainguinal bypass for trauma. In: J Vascular Surgery. Mosby Inc. 2019;70(6):1816–22.
  7. Verwer MC, Wijnand JGJ, Teraa M, Verhaar MC, de Borst GJ. Long term survival and limb salvage in patients with non-revascularisable chronic limb threatening ischaemia. ESVS. 2021;62(2):225–32. doi:10.1016/j.ejvs.2021.04.003
  8. Vatner SF, Zhang J, Vyzas C, Mishra K, Graham RM, Vatner DE. Vascular stiffness in aging and disease. Front Physiol. 2021;12:762437. doi:10.3389/fphys.2021.762437
  9. Tirtasari S, Kodim N. Prevalensi Dan karakteristik hipertensi pada usia dewasa muda di Indonesia. Tarumanagara Medical Journal. 2019;1(2):395–402.
  10. Maharani A, Sujarwoto, Praveen D, Oceandy D, Tampubolon G, Patel A. Cardiovascular disease risk factor prevalence and estimated 10-year cardiovascular risk scores in Indonesia: the SMARThealth extend study. PLoS One. 2019;14(4):e0215219. doi:10.1371/journal.pone.0215219
  11. Al-Zoubi NA, Shatnawi NJ, Khader Y, Heis M, Aleshawi AJ. predictive factors for failure of limb salvage in blunt leg trauma associated with vascular injuries. J Emerg Trauma Shock. 2021;14(2):80–5. doi:10.4103/JETS.JETS_37_20
  12. Song W, Zhou D, Dong J. Predictors of secondary amputation in patients with grade IIIC lower limb injuries. Medicine (United States). 2017;96(22):e7068. doi:10.1097/MD.0000000000007068
  13. Puruhito. Penyakit Arteria. In: Puruhito, editor. Buku Ajar Primer : Ilmu Bedah Toraks, Kardiak, Dan Vaskular. 1st ed. Surabaya: AUP; 2013. p. 347-352
  14. Yu L, Deng L, Zhu S, Deng K, Yu G, Zhu C, et al. Limb-salvage outcomes of arterial repair beyond time limit at different lower-extremity injury sites. Medical Science Monitor. 2020;27:e927652. doi:10.12659/MSM.927652
  15. Soucacos P, Kokkalis. Fractures with Arterial Injury. In: Bentley G, editor. European Surgical Orthopaedics and Traumatology. 1st ed. Heidelberg: Springer Berlin; 2014. p. 183.
  16. Ramdass M, Harnarayan P. A decade of major vascular trauma: Lessons learned from gang and civilian warfare. Ann R Coll Surg Engl. 2017;99(1):70–5. doi:10.1308/rcsann.2016.0296
  17. Kim J, Jeon YS, Cho SG, Hong KC, Park KM. Risk factors of amputation in lower extremity trauma with combined femoropopliteal arterial injury. Vasc Specialist Int. 2019;35(1):16–21. doi:10.5758/vsi.2019.35.1.16
  18. 18. Ramdass MJ, Muddeen A, Harnarayan P, Spence R, Milne D. Risk factors associated with amputation in civilian popliteal artery trauma. Injury. 2018;49(6):1188–92. doi:10.1016/j.injury.2018.04.028
  19. Howard B V, Ruotolo G, Robbins DC. Obesity and dyslipidemia. Endocrinol Metab Clin North Am. 2003;32(4):855–67. doi:10.1016/s0889-8529(03)00073-2
  20. Sabbagh C, Nickinson A, Cullen S, Patel B, Dubkova S, Gray L, et al. The relationship between obesity and amputation-free survival in patients undergoing lower-limb revascularisation for chronic limb-threatening ischaemia: a retrospective cohort study. Ann Vasc Surg. 2022;78:288–94. doi:10.1016/j.avsg.2021.06.022




DOI: https://doi.org/10.15395/mkb.v56.3107

Article Metrics

Abstract view : 97 times
PDF - 76 times

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


 


Creative Commons License
MKB is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 


View My Stats