Observation may be an inadequate approach for injured extremities with single tibial vessel run-off

Anahita Dua, Sapan S. Desai, Sean Johnston, Naga R. Chinapuvvula, Joseph DuBose, Kristofer Charlton-Ouw, Ali Azizzadeh, Andrew Burgess, Charles E. Wade, Charles J. Fox, John B. Holcomb

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Introduction Trauma patients with sudden loss of distal perfusion due to tibial injuries are frequently not offered vascular interventions if a single vessel retains patency. We hypothesized that sudden loss of either all or some tibial vasculature would result in increased non-operative failure and higher amputation rates. Methods In this retrospective observational study, all traumatically injured patients from 2009 to 2012 with CT-angiogram–confirmed anterior tibial, posterior tibial, or peroneal artery injuries were included. Results From 2009 to 2012, 437 patients were admitted with arterial extremity injury of which 234 (53%) were lower extremity. From this group, 84 (36%) patients were identified with CT-angiogram–confirmed limited or no flow in the tibial arteries. A total of 44% (4/9) with 0 or 1 tibial vessel failed observation while only 8% (2/27) failed if they had 2 or 3 patent vessels (p < 0.05). Amputation rate was inversely related the number of open tibial vessels. There were 2.7 open tibial vessels in the limb salvage group compared to 1.1 in the amputation group (p < 0.05). Conclusion Patients who failed an initial trial of observation were significantly more likely to have 0 or 1 tibial vessels patent. The number of open tibial vessels is significantly associated with limb salvage.

Original languageEnglish (US)
Pages (from-to)468-473
Number of pages6
Issue number5
StatePublished - Oct 29 2015


  • Tibial vessels
  • amputation
  • revascularization
  • trauma

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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