Evolving role of endovascular techniques for traumatic vascular injury

Abstract

ENDO procedures for arterial injury have increased over time while mortality for arterial injury subtypes has significantly decreased. Early ENDO procedures are common and are independently associated with a lower risk of mortality. These results suggest outcomes after vascular injury may benefit from ENDO expertise and that ENDO techniques should be incorporated into the early treatment algorithm of trauma patients with vascular injury, particularly those that require difficult operative exposure.

Racial Differences in Treatment Approaches and Mortality Following Arterial Trauma

“…There were important ongoing temporal trends with increasing endovascular therapy utilization for both blunt and penetrating arterial trauma. 36 Interestingly, when evaluated across the racial groups, the rate of adoption of endovascular therapy appeared similar for black and Hispanic patients when compared to white patients for both blunt and penetrating injuries. Thus, disparities in access to new technologies do not appear to explain racial differences in outcomes in arterial injury.…”

The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) registry

“…31,32 There are a number of new training courses designed to familiarize providers with the emergent use of REBOA and other endovascular skills. 31,32 There are a number of new training courses designed to familiarize providers with the emergent use of REBOA and other endovascular skills.…”

Modern Advances in Vascular Trauma

“…[89][90][91] A recent report using the National Trauma Databank (NTDB) showed an increase in endovascular procedures for vascular trauma from 1% of cases in 2002 to nearly 11% in 2008. 92 This same study also showed an independent risk reduction in mortality for subclavian injuries treated with endovascular techniques when analysis was controlled for major confounders. Additional recent work has shown that nearly 6% of all peripheral vascular injuries from 2007 to 2009 reported to the NTDB were approached with an endovascular technique as the initial procedure of choice.…”

“…93 Injuries were also able to be addressed early (<24 hours) in the hospital course even in more severely injured patients. 92 Beyond uses in thoracic aortic trauma, the most literature exists for extension of endovascular repair for subclavian and axillary artery injuries (Fig. 6).…”

“…The largest single-center study to date examined 57 patients with a 100% immediate technical success and a 5% early graft failure. 92 A recent systematic review of the available literature from 1996 to 2012 found a total of 160 cases reported. Short-term success was 96% with long-term graft patency of 84%.…”