TY - JOUR
T1 - Outcomes after External Iliac and Femoral Vascular Injuries
AU - Kim, Jerry J.
AU - Alipour, Hamid
AU - Yule, Arthur
AU - Plurad, David S.
AU - Koopmann, Matthew
AU - Putnam, Brant
AU - de Virgilio, Christian
AU - Kim, Dennis Y.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Background Vascular injuries occurring at the junction of the trunk and lower extremity are uncommon yet challenging because of their location and potential for associated truncal injuries. The purpose of this study was to examine and compare outcomes among patients sustaining external iliac and femoral vascular injuries. Methods We performed a 13-year retrospective analysis of our level 1 trauma center database to identify and compare patients with external iliac and femoral vessel injuries. Multiple logistic regression analysis was performed to identify independent predictors for mortality. Results During the study period, 135 patients with a median (interquartile range [IQR]) age of 25 (20–35) years were identified with external iliac (n = 29) and femoral vascular injuries (n = 106). The majority were male (85.9%) with a penetrating mechanism (84.5%), and the median (IQR) Injury Severity Score (ISS) was 16 (11–26). The overall mortality rate was 14.1%. In comparison with patients with femoral vascular injuries, patients with external iliac injuries presented with higher ISS (25 vs. 16, P < 0.001), lower Glasgow Coma Scale (14 vs. 15, P = 0.001) and had a higher incidence of mortality (41.4% vs. 6.6%, P < 0.001) and disability (13.8% vs. 1%, P = 0.007). Shunts were used in only 7 patients (5.2%). Stepwise logistic regression consistently identified external iliac injury (odds ratio, 15.6; 95% confidence interval, 1.72–141, P = 0.014 in best-fitted model) as independently associated with mortality. Conclusions In comparison with femoral vascular injuries, external iliac vascular injuries are associated with higher blood loss, more intense resuscitation, higher disability and mortality in patients sustaining junctional groin injuries. Early recognition and application of damage control techniques and resuscitative practices may result in improved outcomes.
AB - Background Vascular injuries occurring at the junction of the trunk and lower extremity are uncommon yet challenging because of their location and potential for associated truncal injuries. The purpose of this study was to examine and compare outcomes among patients sustaining external iliac and femoral vascular injuries. Methods We performed a 13-year retrospective analysis of our level 1 trauma center database to identify and compare patients with external iliac and femoral vessel injuries. Multiple logistic regression analysis was performed to identify independent predictors for mortality. Results During the study period, 135 patients with a median (interquartile range [IQR]) age of 25 (20–35) years were identified with external iliac (n = 29) and femoral vascular injuries (n = 106). The majority were male (85.9%) with a penetrating mechanism (84.5%), and the median (IQR) Injury Severity Score (ISS) was 16 (11–26). The overall mortality rate was 14.1%. In comparison with patients with femoral vascular injuries, patients with external iliac injuries presented with higher ISS (25 vs. 16, P < 0.001), lower Glasgow Coma Scale (14 vs. 15, P = 0.001) and had a higher incidence of mortality (41.4% vs. 6.6%, P < 0.001) and disability (13.8% vs. 1%, P = 0.007). Shunts were used in only 7 patients (5.2%). Stepwise logistic regression consistently identified external iliac injury (odds ratio, 15.6; 95% confidence interval, 1.72–141, P = 0.014 in best-fitted model) as independently associated with mortality. Conclusions In comparison with femoral vascular injuries, external iliac vascular injuries are associated with higher blood loss, more intense resuscitation, higher disability and mortality in patients sustaining junctional groin injuries. Early recognition and application of damage control techniques and resuscitative practices may result in improved outcomes.
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U2 - 10.1016/j.avsg.2016.01.005
DO - 10.1016/j.avsg.2016.01.005
M3 - Article
C2 - 26965801
AN - SCOPUS:84962124767
SN - 0890-5096
VL - 33
SP - 88
EP - 93
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
ER -