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OBJECTIVES:Endovascular repair of peripheral arterial trauma is a minimally invasive alternative to open repair in selected patients. The purpose of this study was to evaluate patient outcomes following endovascular repair at an urban level 1 trauma center.
METHODS: Patients who underwent endovascular repair of a traumatic peripheral arterial lesion with a stent graft were selected from a prospectively collected institutional trauma registry. Demographic, imaging, operative, and hospital data were also collected through a supplemental review of the patient’s records.
RESULTS: Between 8/2004 and 6/2012, 28 patients (20 male, median age 35 years, range 13-88) underwent endovascular repair of a traumatic peripheral arterial lesion. The mean injury severity score was 17.2. The mechanism of injury included gunshot wound (N=12), iatrogenic (N=7), blunt (N=7), and stab wound (N=2). Sites of injury included the subclavian or axillary (N=13), femoral or popliteal (N=9), iliac (N=3), and carotid arteries (N=3). Findings on angiography included pseudoaneurysm (N=10), rupture (N=9), occlusion (N=6), and arteriovenous fistula (N=3). Twenty three patients were treated with a single stent graft while five required one or more extensions (Viabahn, WL Gore & Associates, Flagstaff, AZ). The immediate technical success rate was 100%. Secondary procedures were performed in 8 patients. Stent graft thrombosis led to early conversion (< 30 days) in 3 patients and late conversion (> 30 days) in another 3 patients. The stent graft was used as a bridge to open surgery in 2 patients. The overall limb salvage rate was 93%. The mean length of stay was 18.4 days (1-93) and median follow up time 13 months (1-60).
CONCLUSIONS:Endovascular repair of traumatic peripheral arterial lesions is a safe and effective treatment in properly selected patients. The rate of secondary procedures emphasizes the need for long term surveillance.