Department of Surgery, University of California, San Francisco-East Bay, Oakland, California.
Department of Surgery, University of California, San Francisco-East Bay, Oakland, California.
J Surg Res. 2014 Jul;190(1):300-4. doi: 10.1016/j.jss.2014.03.035. Epub 2014 Mar 27.
Treatment of traumatic vascular injury is evolving because of endovascular therapies. National guidelines advocate for embolization of injuries to lower extremity branch vessels, including pseudoaneurysms or arteriovenous fistulas, in hemodynamically normal patients without hard signs of vascular injury. However, patient stability and injury type may limit endovascular applicability at some centers. We hypothesized that for penetrating trauma, indications for endovascular treatment of peripheral vascular injuries, as outlined by national guidelines, are infrequent.
We reviewed records of patients sustaining penetrating peripheral vascular injuries treated at our university-based urban trauma center from 2006-2010. Patient demographics and outcomes were analyzed.
In 92 patients with penetrating peripheral vascular injuries, 82 were managed operatively and 10 were managed nonoperatively. Seventeen (18%) were hemodynamically unstable on arrival, 44 (48%) had multiple vessels injured, and 76 (83%) presented at night and/or on the weekend. No pseudoaneurysms or arteriovenous fistulas were seen initially or at follow-up. Applying national guidelines to our cohort, only two patients (2.2%) met recommended criteria for endovascular treatment.
According to national guidelines, indications for endovascular treatment of penetrating peripheral vascular injury are infrequent. Nearly two-thirds of patients with penetrating peripheral vascular injuries were hemodynamically unstable or had multiple vessels injured, making endovascular repair less desirable. Additionally, over 80% presented at night and/or on the weekend, which could delay treatment at some centers due to mobilization of the endovascular team. Trauma centers need to consider their resources when incorporating national guidelines in their treatment algorithms of penetrating vascular trauma.
由于血管内治疗的发展，外伤性血管损伤的治疗方法也在不断发展。国家指南主张对下肢分支血管（包括假性动脉瘤或动静脉瘘）进行栓塞治疗，适用于血流动力学正常且无明显血管损伤的患者。然而，在某些中心，患者的稳定性和损伤类型可能限制了血管内的适用性。我们假设，对于穿透性创伤，国家指南中概述的用于治疗周围血管损伤的血管内治疗指征并不常见。
我们回顾了 2006 年至 2010 年在我们大学附属医院的城市创伤中心治疗的穿透性周围血管损伤患者的记录。分析了患者的人口统计学和结局。
在 92 例穿透性周围血管损伤患者中，82 例接受了手术治疗，10 例接受了非手术治疗。17 例（18%）入院时血流动力学不稳定，44 例（48%）有多处血管损伤，76 例（83%）在夜间和/或周末就诊。最初或随访时均未发现假性动脉瘤或动静脉瘘。根据国家指南，我们的患者队列中只有 2 例（2.2%）符合血管内治疗的推荐标准。
根据国家指南，穿透性周围血管损伤血管内治疗的指征并不常见。近三分之二的穿透性周围血管损伤患者血流动力学不稳定或有多处血管损伤，使得血管内修复不太理想。此外，超过 80%的患者在夜间和/或周末就诊，这可能会由于血管内团队的调动而导致某些中心的治疗延迟。创伤中心在将国家指南纳入其穿透性血管创伤治疗算法时需要考虑其资源。
