N. Nekooei1, D. Brabender1, A. Siletz1, K. Matsushima1, K. Inaba1, J. Dubose2, M. Martin1 1University Of Southern California, Department Of Acute Care Surgery, Los Angeles, CA, USA 2Dell Medical School, University of Texas at Austin, Department Of Surgery And Perioperative Care, Austin, TX, USA
Introduction: Outcomes following cervical arterial repairs (CAR) in trauma are well-documented but often focus on inpatient complications with limited post-discharge follow-up. This study aims to provide a comprehensive analysis of longer-term outcomes using extended post-discharge data for CAR.
Methods: The PROspective Observational Vascular Injury Treatment (PROOVIT) registry (2012-2023) was queried for patients with injuries to the cervical arteries (common, internal, external carotid, and vertebral arteries) who underwent endovascular or open repair interventions. The recently added post-discharge follow-up PROOVIT module was queried for patients with available follow-up data. Collected data included patient demographics, injury characteristics, signs at presentation, injury severity, type of intervention, and CAR-related vascular complications (VC). Rates of in-hospital and post-discharge vascular complications (VC) were analyzed and compared across specific subgroups, including by repair type and presence or absence of in-hospital VC.
Results: Among 1599 entries with cervical arterial injuries, 140 (9%) required interventions. 77% were male, and 67% sustained penetrating injuries, and median Injury Severity Score was 20.5. CAR included 49% endovascular repair, 19% ligation or shunt only, and 32% arterial repair (primary repair or utilization of grafts). During the hospital stay, 38 (27%) experienced CAR-related complications (32% endovascular ,19% ligation or shunt, 24% arterial repair, p=0.412). In the follow-up data, 40 (29%) patients were identified and were categorized into in-hospital VC (35%) and no in-hospital complication (65%) groups. Among those with an in-hospital VC identified, 7% developed additional post-discharge VCs while the cohort without an in-hospital VC had a 27% incidence of post-discharge VC (p=0.2). Total post-discharge VC rates by intervention type were 12.5% for endovascular, 33% for ligation or shunt only, and 30% for arterial repair (p=0.344, Table 1). Post-discharge VC consisted of 7.5% reinterventions, 7.5% technical problems with original repair, 2.5% pseudoaneurysms, and 2.5% infections.
Conclusion: There is a significant incidence of CAR-related vascular complications after trauma. Noteably, approximately one-third of patients who were complication-free at the time of discharge developed one or more complications identified only by outpatient follow-up. Focused efforts to improve routine follow-up and data capture/analysis in this cohort are warranted.