Endovascular management of traumatic peripheral arterial injuries

BackgroundVascular damage in polytrauma patients is associated with high mortality and morbidity. Therefore, specific clinical implications of vascular damage with fractures in major trauma patients are reassessed.MethodsThis comprehensive nine-year retrospective single center cohort study analyzed demography, laboratory, treatment and outcome data from 3689 patients, 64 patients with fracture-associated vascular injuries were identified and were compared to a control group.Results: Vascular damage occurred in 7% of patients with upper and lower limb and pelvic fractures admitted to the trauma room. Overall survival was 80% in pelvic fracture and 97% in extremity fracture patients and comparable to non-vascular trauma patients. Additional arterial damage required substantial fluid administration and was visible as significantly anemia and disturbed coagulation tests upon admission. Open procedures were done in over 80% of peripheral extremity vascular damage. Endovascular procedures were predominant (87%) in pelvic injury.ConclusionVascular damage is associated with high mortality rates especially in combination with pelvic fractures. Initial anemia, disturbed coagulation tests and the need for extensive pre-clinical fluid substitution were observed in the cohort with vascular damage. Therefore, fast diagnosis and early interventional and surgical procedures are necessary to optimize patient-specific outcome.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2333-y) contains supplementary material, which is available to authorized users.

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“…1). Open fracture, eventual contamination and massive tissue loss require autologous reconstruction [9, 33, 34]. …”

Section: Discussionmentioning

confidence: 99%

Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma

Gilbert

Schneemann

Scholz

et al. 2018

BMC Musculoskelet Disord

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“…6 Unfortunately, for both adult and pediatric populations, long-term follow-up for these interventions is lacking, with variable outcomes reported in the literature. 5,7 Current adult endovascular techniques and devices are too large to accommodate pediatric vessels, which are more prone to iatrogenic dissection, spasm, and thrombosis. This is likely why the mean age of the endovascular cohort in our population was significantly higher than that of our open cohort, as the older children were more likely to have arteries closer to adult size.…”

Section: Discussionmentioning

confidence: 99%

“…Other potential benefits include the avoidance of intracavitary surgery-associated complications, no need for aortic cross-clamping or extracorporeal bypass, and lower transfusion requirements. [1][2][3][4][5][6][7] Overall, there were significant differences in demographics and clinical data between the two cohorts that required data adjustments using logistic regression analysis to account for potential confounders. Endovascular patients were older, were more likely to have sustained blunt trauma, and had higher ISS.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the reports lack long-term follow-up, with variable rates of patency of endovascular interventions. Regardless of unclear longterm efficacy, reported rates of endovascular therapy in adult arterial trauma appear to be increasing, [5][6][7] with early survival benefits noted with endovascular therapy. 6 Although uncommon among children, traumatic arterial injuries remain a significant cause of morbidity and mortality in the civilian setting, with 30-day amputation and death rates exceeding 10% in contemporary studies.…”

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confidence: 99%

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Increasing use of endovascular therapy in pediatric arterial trauma

Branco

Naik‐Mathuria

Montero-Baker

et al. 2017

Journal of Vascular Surgery

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The use of endovascular therapy in pediatric vascular arterial trauma has significantly increased, especially among severely injured blunt trauma patients. Despite this successful integration into care, there was no in-hospital survival advantage conferred by endovascular therapy compared with traditional open therapy. Approximately 10% of children with arterial injuries died during initial trauma assessment before therapy could be offered. Glasgow Coma Scale score ≤8, ISS ≥16, positive result of ethanol or drug screen, and systolic blood pressure <90 mm Hg on admission were identified as independent risk factors for death. As children are a population of vulnerable patients, long-term, multicenter studies are required to determine the most appropriate use of and indications for endovascular therapy in pediatric arterial trauma.

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“…The series on repair of subclavian, axillary, femoral and popliteal arteries have favourable results in short time follow up [3,6]. The potential benefits of endovascular versus open repair consist of: shorter operative duration, less blood loss and less surgical trauma to the patient [7]. The most important technical requirement is safe passage of a guidewire through the injured vessel to restore distal perfusion.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Blunt Traumatic Injury to the Brachial Artery: Case Report and Review of the Literature

Smeets¹

2017

Clin Med Rev Case Rep

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Blunt traumatic injury to the subclavian, axillary or brachial artery is uncommon and could have devastating consequences. Historically open repair is performed however reports of successful endovascular treatments are increasing. A case is described of a seventy one-year-old patient with a blunt injury to his right arm after being crushed in a closing hydraulic door of a truck. He sustained a traumatic dissection of his right brachial artery with associated nerve injury to the brachial plexus. After trauma resuscitation he was successfully treated in the hybrid operation room. Through the common femoral artery a helical stent (Supera) was placed in the injured brachial artery. Postoperative recovery was without complications. Additional treatment for the nerve injury was performed several months after trauma by the neurosurgeon. Functional recovery of his right arm was good except for fine motoric functioning which is still recovering.A review of the literature was performed to identify endovascular repair of blunt traumatic injury to the upper extremity. A total of 28 papers described 55 patients who underwent 56 procedures for subclavian, axillary and brachial injuries. The subclavian artery was affected and treated in 36 patients, in 16 patients axillary injury was treated and only 4 brachial arteries received endovascular repair. Technical success rate of endovascular treatment is good and stent graft patency rates are sufficient. Type of injury which was treated, the follow up technique, anticoagulant therapy and follow up duration varied extensively in the literature. Endovascular treatment of blunt arterial trauma to the upper extremity appears to be feasible. No definite conclusion can be drawn concerning best type of stent graft, best follow up regime or post-operative medical treatment. Treating a patient in a hybrid operation room seems advisable to facilitate conversion to open treatment or treat associated traumatic injuries if necessary.

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Endovascular management of traumatic peripheral arterial injuries

Cited by 23 publications

References 18 publications

Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma

Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma

Increasing use of endovascular therapy in pediatric arterial trauma

Endovascular Treatment of Blunt Traumatic Injury to the Brachial Artery: Case Report and Review of the Literature

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