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Selected Publication:
Hohenberger, G.
Vascular Trauma of the Extremities – Comparison of Outcome and Arterial Stability of the Upper and Lower Limbs
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2019. pp. 119
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- Authors Med Uni Graz:
- Advisor:
- Cohnert Tina Ulrike
- Konstantiniuk Peter
- Matzi Veronika
- Altmetrics:
- Abstract:
- Background/objective: There is limited evidence of the functional posttraumatic differences between upper (UE) and lower extremities (LE) after vascular injuries. This study aimed to compare the functional post-interventional results between UE and LE with inability to return to the preoperative workplace or postoperative loss of at least 10% of the physical fitness questionnaire (FFB-Mot) score (for retirees) as the primary outcome. Further, a biomechanical comparison of the subclavian (SAs) and common iliac arteries (CIAs) was conducted. Materials & Methods: All consecutive patients treated for arterial injuries with vascular reconstruction at a level-I trauma centre and a cooperating level-III trauma centre between January 2005 and December 2014 were assessed. The Mangled Extremity Severity Score (MESS) and the FFB-Mot were determined. The differences between pre- and posttraumatic values were compared statistically for UE and LE. Inability to return to the preoperative workplace (for working people) or postoperative loss of at least 10% of the FFB-Mot score (for retirees) was defined as the primary outcome event. For the biomechanical investigation paired SAs and CIAs of human adult body donors were extracted. Extension-inflation-torsion experiments at different axial stretches, transmural pressures and torsions were conducted. Residual stresses in axial and circumferential direction were determined. Specimens were evaluated via histological and second-harmonic generation imaging investigations. Results: Of 27 patients included in the study, 14 cases involved the UE and 13 the LE. There were no statistically significant differences (p = 0.75) between the mean MESS for UE (5.9; SD: 2.5) and LE (6.2; SD: 2.5). The primary outcome event occurred in 52% (14/27) without significant difference between UE (43%, 6/14) and LE (62%; 8/14) injuries (p = 0.45). However, the difference between the pre- and post-traumatic FFB-Mot scores showed a significantly poorer functional outcome after LE vascular injury (loss of 31.8%) in comparison to the UE (loss of 13.3%; p = 0.012). The biomechanical trial involved arterial samples of 17 body donors. The CIA revealed higher Cauchy stresses in circumferential and axial directions when compared to the SA. The residual stresses in circumferential direction were significantly lower for SA than for CIA at measurements after 30 min and 16 h. The amount of collagen fibres was higher for the CIA (51.4%) when compared to the SA (44.3%) during microstructure evaluation. Conclusions: Results indicate a poorer functional outcome after vascular extremity trauma to the LE than to the UE. The evaluated biomechanical differences may be traced back to different mechanical environments of the arteries.