Endovascular management for peripheral arterial trauma: The new norm?

Abstract 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...

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Bibliographic Details
Published in:	Injury Vol. 48; no. 5; pp. 1025 - 1030
Main Authors:	Ganapathy, Anand, Khouqeer, Ahmed F, Todd, S. Robb, Mills, Joseph L, Gilani, Ramyar
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Ltd 01-05-2017
Subjects:	Adult Angiography Blood Transfusion - statistics & numerical data Endovascular Procedures - methods Endovascular therapy Female Humans Length of Stay Limb Salvage - methods Male Orthopedics Peripheral artery trauma Peripheral Vascular Diseases - diagnosis Peripheral Vascular Diseases - surgery Practice Guidelines as Topic Retrospective Studies Trauma Centers - statistics & numerical data United States - epidemiology Vascular injury Vascular System Injuries - diagnosis Vascular System Injuries - surgery Peripheral artery trauma Endovascular therapy Vascular injury
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Summary:	Abstract 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0020-1383 1879-0267
DOI:	10.1016/j.injury.2017.02.002