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Venous thromboembolism after penetrating femoral and popliteal artery injuries: an opportunity for increased prevention
  1. Asanthi Ratnasekera, DO FACS1,
  2. Odessa Pulido, DO2,
  3. Sandra Durgin, RN MSN1,
  4. Sharon Nichols, ACNP-BC1,
  5. Alicia Lozano, MS3,
  6. Danielle Sienko, MS3,
  7. Alexandra Hanlon, PhD3,
  8. Niels D. Martin, MD FACS4
  1. 1 Department of Surgery, Crozer-Keystone Health System, Upland, Pennsylvania, USA
  2. 2 Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
  3. 3 Department of Statisitics, Virginia Polytechnic Institute and State University, Center for Biostatistics and Health Data Science, Roanoke, Virginia, USA
  4. 4 Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Asanthi Ratnasekera DO FACS; ashanthi27{at}


Background Trauma patients with penetrating vascular injuries have a higher rate of venous thromboembolism (VTE). The objective of this study was to determine the risk of VTE formation in penetrating femoral and popliteal vascular injuries and the effects of endovascular management of these injuries.

Methods A retrospective study of Pennsylvania Trauma Outcome Study registry was conducted during a 5-year period (2013–2017). All adult patients with a penetrating mechanism with femoral/popliteal vascular injuries were studied. Primary outcome was incidence of VTE in patients with isolated arterial injuries versus combined arterial/venous injuries. Secondary endpoints were intensive care unit (ICU) length of stay (LOS), hospital LOS and mortality. Statistical comparisons were accomplished using Fisher’s exact tests, and parametric two-sample t-tests or non-parametric Wilcoxon rank-sum tests for categorical and continuous variables, respectively.

Results Of the 865 patients with penetrating extremity vascular injuries, 207 had femoral or popliteal artery injuries. Patients with isolated arterial injuries (n=131) had a significantly lower deep venous thrombosis (DVT) rate compared with those with concurrent venous injuries (n=76) (3.1% vs. 13.2%, p=0.008). There were 14 patients in the study who developed DVTs. Among the four patients with isolated femoral or popliteal arterial injuries who had developed DVTs, three had an open repair. Among patients with isolated arterial injuries, those with DVT spend significantly more time on the ventilator (median=2 vs. 0, p=0.0020) compared with patients without DVT. Patients with DVT also had longer stay in the hospital (median=17.5 vs. 8, p=0.0664) and in the ICU (median=3 vs. 1, p=0.0585).

Conclusions Risk of DVT exists in patients with penetrating isolated femoral and popliteal artery trauma. Open repair was associated with significantly higher DVT rates in isolated arterial injuries.

Level of evidence Level IV therapeutic care/management.

  • venous thromboembolism
  • penetrating trauma
  • femoral artery
  • popliteal artery

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  • Contributors AR, OP, SN, and SD performed the literature search. AR, SN, SD, and NM created the study design. AR, OP, SN, and SD participated in data collection. AR, NM, AL, DS, and AH performed data analysis and data interpretation. AR, NM, SD, AL, DS, and AH participated in writing and critical revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional Review Board of Crozer-Keystone Health System and the Research Committee of the Pennsylvania Trauma System Foundation (PTSF).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data from the PTOS registry were deidentified.

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