Utilization of endovascular and open surgical repair in the United States: A 10-year analysis of the National Trauma Databank (NTDB)

Background: Endovascular therapy provides a less invasive alternative to open surgery for critically ill patients who have sustained arterial injuries. The purpose of this study was to evaluate recent trends in the management of arterial injuries in the United States with specific reference to the use of endovascular strategies and to examine the outcomes of endovascular vs open therapy for the treatment of civilian arterial traumatic injuries. Methods: We performed a 10-year (2004–2014) analysis of ACS-NTDB and identified all adult trauma patients who had arterial injuries. Data regarding demographics, injury parameters, endovascular or open vascular repair and outcomes were extracted. Cochran-Armitage trend analysis and multivariate logistic regression analysis were performed. Results: A total of 111,061 patients with arterial injuries were identified and included in our analysis. Mean age was 39 ± 19y, 82% were male and 79% were white. The most common artery injured was iliac artery followed by brachial artery and thoracic aorta. Overall 6.7% (7434) patients underwent endovascular repair while 38.8% (42,495) had open vascular repair. The rate of endovascular repair increased from 3.1% to 8.9% while the incidence of open vascular repair decreased from 47% to 32% over the study period. Patients in endovascular group had lower ISS compared to patients in open vascular repair group (17 + 10 vs 24 + 10, p < 0.001). Patients who underwent endovascular repair had shorter hospital length of stay (days: 10 + 17 vs 11 + 15, p < 0.001), lower mortality (8% vs 14%, p = 0.01). On multivariate regression analysis after controlling for confounding variables, endovascular repair was independently associated with improved survival (OR: 2.45[1.84–4.26], p = 0.01). Conclusions: The use of endovascular modalities to repair arterial injuries in the setting of acute trauma is increasing in a dramatic fashion. Endovascular repair of trauma arterial injuries is associated with shorter length of stay and improved survival compared to open vascular procedures.