In-Hospital Risk Factors for Reintervention and Amputation in Femoral Arterial Trauma

Introduction: Known risk factors for surgical reintervention of traumatic femoral artery injuries include thrombosis of vascular reconstruction, kinking of anastomosis, and iatrogenic injury. The literature regarding possible in-hospital risk factors is sparse. We sought to identify risk factors associated with increased reintervention and amputation in this civilian population. Methods: The AAST PROspective Observational Vascular Injury Trial registry was queried for all patients who underwent traumatic femoral arterial repair from 2013 to 2022. Patients with documented need for reintervention and amputation were compared to those without. Results: Three hundred and seventy-six patients required femoral artery repair, 33 (8.8%) needed reintervention, and 21 (5.6%) needed amputation. There was a significant increase in amputation with very high energy injuries and vessel ligation. Intraoperative heparin trended toward significance in protecting against need for reoperation and had a significant decrease in amputations. Postoperative anticoagulation, shunting, and injury repair type showed no difference. Conclusions: This study shows intraoperative heparin and lower energy impact injuries were associated with a lower incidence of limb loss. Further prospective studies are needed to evaluate the effect on reintervention.