Outcomes after External Iliac and Femoral Vascular Injuries

Jerry J. Kim, Hamid Alipour, Arthur Yule, David S. Plurad, Matthew Koopman, Brant Putnam, Christian de Virgilio, Dennis Y. Kim

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)88-93
Number of pages6
JournalAnnals of Vascular Surgery
Volume33
DOIs
StatePublished - May 1 2016
Externally publishedYes

Fingerprint

Vascular System Injuries
Thigh
Mortality
Wounds and Injuries
Injury Severity Score
Logistic Models
Glasgow Coma Scale
Groin
Trauma Centers
Resuscitation
Lower Extremity
Odds Ratio
Regression Analysis
Databases
Confidence Intervals
Incidence

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Kim, J. J., Alipour, H., Yule, A., Plurad, D. S., Koopman, M., Putnam, B., ... Kim, D. Y. (2016). Outcomes after External Iliac and Femoral Vascular Injuries. Annals of Vascular Surgery, 33, 88-93. https://doi.org/10.1016/j.avsg.2016.01.005

Outcomes after External Iliac and Femoral Vascular Injuries. / Kim, Jerry J.; Alipour, Hamid; Yule, Arthur; Plurad, David S.; Koopman, Matthew; Putnam, Brant; de Virgilio, Christian; Kim, Dennis Y.

In: Annals of Vascular Surgery, Vol. 33, 01.05.2016, p. 88-93.

Research output: Contribution to journalArticle

Kim, JJ, Alipour, H, Yule, A, Plurad, DS, Koopman, M, Putnam, B, de Virgilio, C & Kim, DY 2016, 'Outcomes after External Iliac and Femoral Vascular Injuries', Annals of Vascular Surgery, vol. 33, pp. 88-93. https://doi.org/10.1016/j.avsg.2016.01.005
Kim, Jerry J. ; Alipour, Hamid ; Yule, Arthur ; Plurad, David S. ; Koopman, Matthew ; Putnam, Brant ; de Virgilio, Christian ; Kim, Dennis Y. / Outcomes after External Iliac and Femoral Vascular Injuries. In: Annals of Vascular Surgery. 2016 ; Vol. 33. pp. 88-93.
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abstract = "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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AU - Koopman, Matthew

AU - Putnam, Brant

AU - de Virgilio, Christian

AU - Kim, Dennis Y.

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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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