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- Title
Outcome Predictors in Civilian and Iatrogenic Arterial Trauma.
- Authors
Kakkos, Stavros K.; Tyllianakis, Minos; Panagopoulos, Andreas; Kokkalis, Zinon; Lianou, Ioanna; Koletsis, Efstratios; Tsolakis, Ioannis; Papadoulas, Spyros; Gliatis, John; Maroulis, Ioannis; Kitrou, Panagiotis
- Abstract
Background: Our aim was to identify predictors of mortality and limb loss in iatrogenic and civilian arterial trauma. Methods: Cases were identified by searching prospectively maintained registries. Multivariable logistic regression was used to identify independent outcome predictors. Results: During the study period, 285 patients with arterial trauma were managed with endovascular (n = 20) or open (n = 265) repair. Iatrogenic injuries increased in frequency during the course of the study, from 23.9% during the first decade to 35.9 and 55.7% during the second and third decade, respectively (p < 0.001). Endovascular management increased in frequency during the course of the study, from 0% during the first decade to 5.1 and 11.1% during the second and third decade, respectively (p = 0.005). Mortality was 9.8%, and limb loss (in cases with injury of the aorta or limb arteries, n = 259) was 6.2%. Independent predictors of mortality included increased age (odds ratio, 95% confidence interval [OR, 95% CI] 1.05 (1.02–1.07), p < 0.001), blunt trauma (OR [95% CI] 4.8 (1.9–12.2), p = 0.001) and the number of RBC units transfused intraoperatively (OR [95% CI] 1.25 (1.1–1.4), p = 0.001). Independent predictors of limb loss included the first half of the study period (OR [95% CI] 3.9 (1.1–14.1), p = 0.04), lower extremity arterial trauma (vs upper extremity, aortic, common or external iliac artery trauma, OR [95% CI] 8.3 (1.9–35.7), p = 0.004), bone fracture (OR [95% CI] 16.9 (4.7–62.5), p < 0.001) and the number of RBC units transfused intraoperatively (OR [95% CI] 1.16 (1.02–1.33), p = 0.024). Conclusion: Increasingly iatrogenic in cause and managed by endovascular methods, arterial trauma remains a problem associated with significant mortality and limb loss. Identification of unfavourable outcome predictors may help clinicians involved with arterial trauma to escalate the level of care.
- Subjects
IATROGENIC diseases; ENDOVASCULAR surgery; ILIAC artery; MORTALITY; BLUNT trauma
- Publication
World Journal of Surgery, 2021, Vol 45, Issue 1, p160
- ISSN
0364-2313
- Publication type
Article
- DOI
10.1007/s00268-020-05792-9