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Use of open and endovascular surgical techniques to manage vascular injuries in the trauma setting: A review of the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Trial registry

Faulconer, Edwin, R., MBBS; Branco, Bernardino, C., MD; Loja, Melissa, N., MD; Grayson, Kevin, PhD; Sampson, James, MD; Fabian, Timothy, C., MD; Holcomb, John, B., MD; Scalea, Thomas, MD; Skarupa, David, MD; Inaba, Kenji, MD; Poulin, Nathaniel, MD; Rasmussen, Todd, E., MD; Dubose, Joseph, J., MD

Journal of Trauma and Acute Care Surgery: March 2018 - Volume 84 - Issue 3 - p 411–417
doi: 10.1097/TA.0000000000001776
AAST 2017 Podium Paper
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BACKGROUND Vascular trauma data have been submitted to the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Trial (PROOVIT) database since 2013. We present data to describe current use of endovascular surgery in vascular trauma.

METHODS Registry data from March 2013 to December 2016 were reviewed. All trauma patients who had an injury to a named artery, except the forearm and lower leg, were included. Arteries were grouped into anatomic regions and by compressible and noncompressible region for analysis. This review focused on patients with noncompressible transection, partial transection, or flow-limiting defect injuries. Bivariate and multivariate analyses were used to assess the relationships between study variables.

RESULTS One thousand one hundred forty-three patients from 22 institutions were included. Median age was 32 years (interquartile range, 23–48) and 76% (n = 871) were male. Mechanisms of injury were 49% (n = 561) blunt, 41% (n = 464) penetrating, and 1.8% (n = 21) of mixed aetiology. Gunshot wounds accounted for 73% (n = 341) of all penetrating injuries. Endovascular techniques were used least often in limb trauma and most commonly in patients with blunt injuries to more than one region. Penetrating wounds to any region were preferentially treated with open surgery (74%, n = 341/459). The most common indication for endovascular treatment was blunt noncompressible torso injuries. These patients had higher Injury Severity Scores and longer associated hospital stays, but required less packed red blood cells, and had lower in hospital mortality than those treated with open surgery. On multivariate analysis, admission low hemoglobin concentration and abdominal injury were independent predictors of mortality.

CONCLUSION Our review of PROOVIT registry data demonstrates a high utilization of endovascular therapy among severely injured blunt trauma patients primarily with noncompressible torso hemorrhage. This is associated with a decreased need for blood transfusion and improved survival despite longer length of stay.

Level of Evidence Therapeutic/care management, level III.

From the Department of Vascular Surgery (E.R.F., J.S., J.J.D.), David Grant USAF Medical Center, Travis AFB, Fairfield, California; Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery (B.C.B.), Baylor College of Medicine, Houston, Texas; Department of Vascular Surgery (M.N.L.), University of California Davis Medical Center, Sacramento; Clinical Investigations Facility, David Grant USAF Medical Center (K.G.), Travis AFB, Fairfield, California; Department of Surgery (T.C.F.), University of Tennessee-Memphis, Memphis, Tennessee; Department of Surgery (J.B.H.), University of Texas Health Sciences Center-Houston, Houston, Texas; R Adams Cowley Shock Trauma Center (T.S.), University of Maryland, Baltimore, Maryland; Department of Surgery (D.S.), University of Florida, Jacksonville, Florida; Department of Surgery (K.I.), Department of Surgery (K.I.), Los Angeles County + University of Southern California Medical Center, Los Angeles, California; Department of Surgery (N.P.), East Carolina Medical Center, Benson, North Carolina; and Department of Surgery (T.E.R.), United Services Uniformed School of Health Sciences, Bethesda, Maryland.

Submitted: August 31, 2017, Revised: November 2, 2017, Accepted: November 18, 2017, Published online: December 20, 2017.

Address for reprints: Edwin R. Faulconer MBBS FRCS, Department of Vascular Surgery, David Grant USAF Medical Center, Travis AFB, CA; email: robfaulconer@doctors.org.uk.

Presentation: Presented at the American Association for the Surgery of Trauma 76th Annual Meeting in Baltimore, 13-16th September 2017 in session XIIIB — Outcomes/Guidelines.

© 2018 Lippincott Williams & Wilkins, Inc.