Scott Aaron R, Gilani Ramyar, Tapia Nicole M, Mattox Kenneth L, Wall Matthew J, Suliburk James W
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
J Surg Res. 2015 Dec;199(2):557-63. doi: 10.1016/j.jss.2015.04.086. Epub 2015 May 8.
Traumatic injuries to peripheral arterial vessels are increasingly managed with endovascular techniques. Early small series have suggested that endovascular therapy is feasible and decreases operative blood loss, but these data are limited. The purpose of this study was to evaluate the feasibility and outcomes of endovascular management of nonaortic arterial trauma.
We reviewed records of traumatic nonaortic arterial injuries presenting at an urban level 1 trauma center from December 2009-July 2013. Patients undergoing treatment in interventional radiology and patients whose injuries occurred >72 h before presentation were excluded. Demographics, indicators of injury severity, operative blood loss, transfusion requirements, and clinical outcome were compared between patients undergoing endovascular and open management using appropriate inferential statistics.
During the study period, 17 patients underwent endovascular interventions and 20 had open surgery. There were 19 upper extremity and/or thoracic outlet arterial injuries, 15 lower extremity injuries and 11 pelvic injuries. Endovascular cases were completed using a vascular imaging C-arm in a standard operating room. Estimated blood loss during the primary procedure was significantly lower with endovascular management (150 versus 825 cc, P < 0.001). No differences were observed between cohorts in age, injury severity score, intensive care unit length of stay, arterial pH, transfusion requirements, inpatient complication rate, or mortality.
Our experience with endovascular management demonstrates its feasibility with commonly available tools. Operative blood loss may be significantly decreased using endovascular techniques. Further study is needed to refine patient selection criteria and to define long-term outcomes.
外周动脉血管创伤越来越多地采用血管内技术进行处理。早期的小样本研究表明，血管内治疗是可行的，并且可减少术中失血，但这些数据有限。本研究的目的是评估非主动脉动脉创伤血管内治疗的可行性和疗效。
我们回顾了2009年12月至2013年7月在一家城市一级创伤中心就诊的创伤性非主动脉动脉损伤患者的记录。排除在介入放射科接受治疗的患者以及受伤后超过72小时才就诊的患者。使用适当的推断统计学方法，比较接受血管内治疗和开放手术治疗的患者的人口统计学特征、损伤严重程度指标、术中失血、输血需求和临床结局。
在研究期间，17例患者接受了血管内介入治疗，20例接受了开放手术。有19例上肢和/或胸廓出口动脉损伤、15例下肢损伤和11例骨盆损伤。血管内治疗病例在标准手术室使用血管成像C形臂完成。血管内治疗在初次手术期间的估计失血量明显更低（150毫升对825毫升，P<0.001）。两组在年龄、损伤严重程度评分、重症监护病房住院时间、动脉pH值、输血需求、住院并发症发生率或死亡率方面未观察到差异。
我们血管内治疗的经验表明，使用常用工具它是可行的。采用血管内技术可显著减少术中失血。需要进一步研究以完善患者选择标准并确定长期结局。
