TY - JOUR
T1 - Endovascular management for peripheral arterial trauma
T2 - The new norm?
AU - Ganapathy, Anand
AU - Khouqeer, Ahmed F.
AU - Todd, S. Robb
AU - Mills, Joseph L
AU - Gilani, Ramyar
N1 - Publisher Copyright:
© 2017 Elsevier Ltd
PY - 2017/5
Y1 - 2017/5
N2 - Background Endovascular therapy is well studied in atraumatic conditions; and there appears to be a growing interest in its application to traumatic injuries. The objective of this study is to compare open and endovascular techniques in the management of peripheral arterial trauma. Methods This is a retrospective review of patients admitted to a Level I Trauma Center sustaining injuries to the subclavian, axillary, superficial femoral, and popliteal arteries. Demographics, surgical interventions, complications, and clinical outcomes were evaluated in patients requiring open or endovascular repair between 2009 and 2015. Results Sixty-eight patients with 70 total arterial injuries were identified. There were 10 subclavian, 14 axillary, 15 superficial femoral, and 31 popliteal artery injuries. Endovascular (n = 20) compared to open repairs (n = 50) were more commonly performed: by vascular surgeons (90% vs. 54%, p = 0.01); in older patients (median age: 38 years vs. 25, p = 0.01); primarily involving upper extremity injuries (60% vs. 24%, p = 0.01). Furthermore, endovascular repairs less commonly required fasciotomy (15% vs. 46%, p = 0.03) and trended towards lower transfusion requirements (50% vs. 77%, p = 0.06). Patients undergoing open repair had lower pre-hospital systolic blood pressures (110 vs. 120, p = 0.03) and lower initial hematocrit (31.5 vs. 36.2, p = 0.02). However, outcomes between groups were trending higher in the endovascular group with respect to limb salvage rates at discharge (94% vs. 89%), median length of stay (14 days vs. 9), and median follow-up (288 days vs. 92) compared to the open group, but the data were not statistically significant. There was increasing utilization of endovascular repair over time (7% of total procedures in 2009; 50% in 2014). Conclusions Overall, endovascular and open techniques were not statistically different in early outcomes. Endovascular therapy appears to provide some advantage when it comes to: challenging anatomy, decreasing blood product utilization, and minimizing physiologic derangement. However, patients with injuries resulting in free hemorrhage or significant external blood loss may still be best served with open repair. Despite this, given the increasing use of endovascular techniques, close collaboration is needed between trauma and endovascular specialists to properly select the optimal management for patients with peripheral arterial trauma.
AB - Background Endovascular therapy is well studied in atraumatic conditions; and there appears to be a growing interest in its application to traumatic injuries. The objective of this study is to compare open and endovascular techniques in the management of peripheral arterial trauma. Methods This is a retrospective review of patients admitted to a Level I Trauma Center sustaining injuries to the subclavian, axillary, superficial femoral, and popliteal arteries. Demographics, surgical interventions, complications, and clinical outcomes were evaluated in patients requiring open or endovascular repair between 2009 and 2015. Results Sixty-eight patients with 70 total arterial injuries were identified. There were 10 subclavian, 14 axillary, 15 superficial femoral, and 31 popliteal artery injuries. Endovascular (n = 20) compared to open repairs (n = 50) were more commonly performed: by vascular surgeons (90% vs. 54%, p = 0.01); in older patients (median age: 38 years vs. 25, p = 0.01); primarily involving upper extremity injuries (60% vs. 24%, p = 0.01). Furthermore, endovascular repairs less commonly required fasciotomy (15% vs. 46%, p = 0.03) and trended towards lower transfusion requirements (50% vs. 77%, p = 0.06). Patients undergoing open repair had lower pre-hospital systolic blood pressures (110 vs. 120, p = 0.03) and lower initial hematocrit (31.5 vs. 36.2, p = 0.02). However, outcomes between groups were trending higher in the endovascular group with respect to limb salvage rates at discharge (94% vs. 89%), median length of stay (14 days vs. 9), and median follow-up (288 days vs. 92) compared to the open group, but the data were not statistically significant. There was increasing utilization of endovascular repair over time (7% of total procedures in 2009; 50% in 2014). Conclusions Overall, endovascular and open techniques were not statistically different in early outcomes. Endovascular therapy appears to provide some advantage when it comes to: challenging anatomy, decreasing blood product utilization, and minimizing physiologic derangement. However, patients with injuries resulting in free hemorrhage or significant external blood loss may still be best served with open repair. Despite this, given the increasing use of endovascular techniques, close collaboration is needed between trauma and endovascular specialists to properly select the optimal management for patients with peripheral arterial trauma.
KW - Endovascular therapy
KW - Peripheral artery trauma
KW - Vascular injury
UR - http://www.scopus.com/inward/record.url?scp=85012025606&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85012025606&partnerID=8YFLogxK
U2 - 10.1016/j.injury.2017.02.002
DO - 10.1016/j.injury.2017.02.002
M3 - Article
C2 - 28193445
AN - SCOPUS:85012025606
SN - 0020-1383
VL - 48
SP - 1025
EP - 1030
JO - Injury
JF - Injury
IS - 5
ER -