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Outcome Predictors in Civilian and Iatrogenic Arterial Trauma

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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.

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Acknowledgements

The study was approved by the institutional review board.

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Authors and Affiliations

  1. Department of Vascular Surgery, University of Patras Medical School, Patras, Greece

    Stavros K. Kakkos, Ioannis Tsolakis & Spyros Papadoulas

  2. Department of Orthopedic Surgery, University of Patras Medical School, Patras, Greece

    Minos Tyllianakis, Andreas Panagopoulos, Zinon Kokkalis, Ioanna Lianou & John Gliatis

  3. Department of Cardiothoracic Surgery, University of Patras Medical School, Patras, Greece

    Efstratios Koletsis

  4. Department of Surgery, University of Patras Medical School, Patras, Greece

    Ioannis Maroulis

  5. Department of Interventional Radiology, University of Patras Medical School, Patras, Greece

    Panagiotis Kitrou

Authors
  1. Stavros K. Kakkos
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  2. Minos Tyllianakis
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  3. Andreas Panagopoulos
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  4. Zinon Kokkalis
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  5. Ioanna Lianou
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  6. Efstratios Koletsis
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  7. Ioannis Tsolakis
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  8. Spyros Papadoulas
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  9. John Gliatis
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  10. Ioannis Maroulis
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  11. Panagiotis Kitrou
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Correspondence to Stavros K. Kakkos.

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Kakkos, S.K., Tyllianakis, M., Panagopoulos, A. et al. Outcome Predictors in Civilian and Iatrogenic Arterial Trauma. World J Surg 45, 160–167 (2021). https://doi.org/10.1007/s00268-020-05792-9

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  • DOI: https://doi.org/10.1007/s00268-020-05792-9

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