B. K. Richmond1, A. F. AbuRahma1 1West Virginia University/Charleston Division,Department Of Surgery,Charleston, WV, USA
Introduction:
Controversy exists in vascular trauma regarding the best method of treatment – open vs. endovascular techniques. Little has been published on this complex topic.
Methods:
Patients from 2005-2013 at a Level 1 trauma center with vascular injury/repair were identified via a prospectively maintained registry. Patient data, injury type/severity, treatment and 30 day outcomes were obtained from the trauma registry and chart review. Adverse events (limb loss, major disability, death) were outcomes of interest. Univariate analysis and multivariate logistic regression were used to identify predictors of adverse events.
Results:
In all, 346 patients were included (median age 34, range 1- 93 years) Median injury severity score (ISS) was 10(1- 59). Endovascular repairs (n=52)increased from 0%(2005) to 32%(2013), and demonstrated equivalent outcomes to open approaches(p = 0.24). On multivariate analysis, higher ISS(p =0.001), increasing age (p=0.01) and lower extremity injuries (p=0.001) were associated with adverse outcomes across the entire series. Endovascular approaches were most commonly utilized in vascular injuries of the chest/abdomen (39 of 52, 75% of all endovascular procedures in the series,p<0.001), older patients (p=0.003), blunt injury mechanism(p<0.001), and patients with a higher ISS at presentation(p<0.001).
Conclusions:
In this large series, the use of endovascular procedures increased over time, and was associated with equivalent outcomes to open approaches, despite their higher usage in older patients, those with chest/abdominal injuries, and those with a higher ISS at presentation. These results are encouraging and stress the need for further prospective study into the role of endovascular therapies in the treatment of vascular injuries.
