ILIAC ARTERY ISCHEMIC - ANALYSIS OF RISKS FOR ISCHEMIC COMPLICATIONS

Risk factors for lower extremity ischemic complications (ICs) followin g iliac arterial injuries have not been addressed. Patients with penet rating iliac artery injuries over a 15-year period were reviewed. IC w as defined as compartment syndrome with or without tissue loss. Patien ts with iliac artery repair who developed ICs were compared with those without ICs (excluding early deaths from hemorrhagic shock). Comparis on included demographics, severity of shock, physical examination, and operative findings. There were 94 arterial injuries in 80 patients (3 4 common iliac, 23 internal iliac, and 37 external iliac). There were 26 deaths (33%), and 3 patients were excluded for technical reasons. O f the 51 who underwent arterial reconstruction, 34 had no ischemia, wh ereas 17 (33%) had ICs (9 with tissue loss and 8 with compartment synd rome only). Immediate fasciotomies were performed in 6 of the IC patie nts due to the early recognition of compartment syndrome; 1 required a mputation from the profound ischemia. Delayed recognition of compartme nt syndrome in the remaining II IC patients resulted in eight amputati ons (P < 0.05). We conclude that ICs following iliac arterial injuries significantly correlate with shock as indicated by systemic pH, lacta te and transfusion requirements, and a preoperative pulseless extremit y. In these patients, close monitoring of compartment pressures is nec essary, and immediate fasciotomies should be strongly considered.