1. Endovascular treatment of penetrating arterial trauma with stent grafts
- Author
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José Carlos Ingrund, Felipe Nasser, Marcelo Calil Burihan, Rodrigo Bruno Biagioni, and Luisa Ciucci Biagioni
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Wounds, Penetrating ,030204 cardiovascular system & hematology ,Prosthesis Design ,Sepsis ,Blood Vessel Prosthesis Implantation ,Young Adult ,03 medical and health sciences ,Injury Severity Score ,0302 clinical medicine ,medicine ,Electronic Health Records ,Humans ,Endovascular treatment ,Aged ,Retrospective Studies ,business.industry ,Medical record ,Mortality rate ,Endovascular Procedures ,Infant ,Stent ,030208 emergency & critical care medicine ,Arteries ,Middle Aged ,Vascular System Injuries ,Arterial catheter ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Penetrating trauma - Abstract
Abstract. Background: The endovascular management of arterial injuries has resulted in reduced operating time, blood loss, hospital mortality, lower incidence of sepsis, and decrease in mortality rates. For penetrating trauma, however, the benefits of endovascular therapy are questionable. Patients and methods: Data were obtained by retrospective analysis of electronic medical records. All patients with vascular trauma seeking care at our institution from January 2010 to December 2015 were reviewed. A total of 223 vascular trauma patients were enrolled. Of these, 18 patients (8 %) were treated with endovascular techniques. The data related to clinical presentation, patient characteristics, technical aspects of the treatment, and follow-up were analysed. Results: The mean patient age was 35.4 ± 17.8 years, 94 % were male. The mean injury severity score was 10.4 ± 2.5. The most commonly observed trauma mechanism was a gunshot in 10 cases (55 %), followed by lesions provoked by arterial catheter misplacement in five cases (27 %), and stab wounds in three cases (16.6 %). The main injury site was the subclavian artery, accounting for eight cases (44 %), followed by the superficial femoral artery and the tibiofibular trunk in two cases, respectively (18 %). The anterior tibial, fibular artery, axillary, common carotid, superior mesenteric, and profunda femoris were each affected once. Arteriovenous fistula was detected in nine cases (50 %), pseudoaneurysms in nine cases (50 %), and short occlusion in two cases (11 %). The mean follow-up duration was 753 days. The primary patency rate was 92.3 and 61.5 % after one and two years, respectively. The survival rate was 94.4 % after one and two years. Infection of the stents or limb amputations were not identified at follow-up. Conclusions: The endovascular treatment of penetrating arterial injuries with covered stents is feasible. However, the criteria used to choose the best method must be individualized. Keywords: Trauma, endovascular, stent graft, gunshot, stab wound
- Published
- 2018