Open AccessContemporary Management of Axillo-subclavian Arterial Injuries Using Data from the AAST PROOVIT Registry
Author(s) -
Grahya Guntur,
Joseph J. DuBose,
Tiffany K. Bee,
Timothy C. Fabian,
Jonathan J. Morrison,
David Skarupa,
Kenji Inaba,
Rishi Kundi,
Thomas M. Scalea,
David V. Feliciano
Publication year - 2021
Publication title -
journal of endovascular resuscitation and trauma management
Language(s) - English
Resource type - Journals
eISSN - 2003-539X
pISSN - 2002-7567
DOI - 10.26676/jevtm.v5i2.201
Subject(s) - medicine , surgery , demographics , amputation , observational study , pseudoaneurysm , aneurysm , demography , sociology
Background: Endovascular repair has emerged as a viable repair option for axillosubclavian arterial injuries in select patients; however, further study of contemporary outcomes is warranted.
Methods: The American Association for the Surgery of Trauma (AAST) PROspective Observational Vascular Injury Treatment (PROOVIT) registry was used to identify patients with axillo-subclavian arterial injuries from 2013 – 2019. Demographics and outcomes were compared between patients undergoing endovascular repair versus open repair.
Results: 167 patients were identified, with intervention required in 107 (64.1%). Among these, 24 patients underwent open damage control surgery (primary amputation = 3, ligation = 17, temporary vascular shunt = 4). The remaining 83 patients (91.6% male; mean age 26.0 ± 16) underwent either endovascular repair (36, 43.4%) or open repair (47, 56.6%). Patients managed with definitive endovascular or open repair had similar demographics and presentation, with the only exception that endovascular repair was more commonly employed for traumatic pseudoaneurysms (p=0.004). Endovascular repair was associated with lower 24-hour transfusion requirements (p=0.012), but otherwise the two groups were similar with regards to in-hospital outcomes.
Conclusion: Endovascular repair is now employed in > 40% of axillo-subclavian arterial injuries undergoing repair at initial operation and is associated with lower 24 hour transfusion requirements, but otherwise outcomes are comparable to open repair.