Kim Jerry J, Alipour Hamid, Yule Arthur, Plurad David S, Koopmann Matthew, Putnam Brant, de Virgilio Christian, Kim Dennis Y
Harbor-UCLA Medical Center, Department of Surgery, Torrance, CA.
Harbor-UCLA Medical Center, Department of Surgery, Torrance, CA.
Ann Vasc Surg. 2016 May;33:88-93. doi: 10.1016/j.avsg.2016.01.005. Epub 2016 Mar 8.
Vascular injuries occurring at the junction of the trunk and lower extremity are uncommon yet challenging because of their location and potential for associated truncal injuries. The purpose of this study was to examine and compare outcomes among patients sustaining external iliac and femoral vascular injuries.
We performed a 13-year retrospective analysis of our level 1 trauma center database to identify and compare patients with external iliac and femoral vessel injuries. Multiple logistic regression analysis was performed to identify independent predictors for mortality.
During the study period, 135 patients with a median (interquartile range [IQR]) age of 25 (20-35) years were identified with external iliac (n = 29) and femoral vascular injuries (n = 106). The majority were male (85.9%) with a penetrating mechanism (84.5%), and the median (IQR) Injury Severity Score (ISS) was 16 (11-26). The overall mortality rate was 14.1%. In comparison with patients with femoral vascular injuries, patients with external iliac injuries presented with higher ISS (25 vs. 16, P < 0.001), lower Glasgow Coma Scale (14 vs. 15, P = 0.001) and had a higher incidence of mortality (41.4% vs. 6.6%, P < 0.001) and disability (13.8% vs. 1%, P = 0.007). Shunts were used in only 7 patients (5.2%). Stepwise logistic regression consistently identified external iliac injury (odds ratio, 15.6; 95% confidence interval, 1.72-141, P = 0.014 in best-fitted model) as independently associated with mortality.
In comparison with femoral vascular injuries, external iliac vascular injuries are associated with higher blood loss, more intense resuscitation, higher disability and mortality in patients sustaining junctional groin injuries. Early recognition and application of damage control techniques and resuscitative practices may result in improved outcomes.
发生在躯干与下肢交界处的血管损伤并不常见，但因其位置及合并躯干损伤的可能性而具有挑战性。本研究的目的是检查并比较遭受髂外血管和股血管损伤患者的治疗结果。
我们对一级创伤中心数据库进行了为期13年的回顾性分析，以识别并比较患有髂外血管和股血管损伤的患者。进行多因素逻辑回归分析以确定死亡率的独立预测因素。
在研究期间，共识别出135例患者，其中位（四分位间距[IQR]）年龄为25（20 - 35）岁，患有髂外血管损伤（n = 29）和股血管损伤（n = 106）。大多数为男性（85.9%），致伤机制为穿透伤（84.5%），中位（IQR）损伤严重程度评分（ISS）为16（11 - 26）。总体死亡率为14.1%。与股血管损伤患者相比，髂外血管损伤患者的ISS更高（25对16，P < 0.001），格拉斯哥昏迷量表评分更低（14对15，P = 0.001），死亡率（41.4%对6.6%，P < 0.001）和残疾发生率（13.8%对1%，P = 0.007）更高。仅7例患者（5.2%）使用了分流术。逐步逻辑回归始终将髂外血管损伤（优势比，15.6；95%置信区间，1.72 - 141，最佳拟合模型中P = 0.014）确定为与死亡率独立相关。
与股血管损伤相比，髂外血管损伤在腹股沟交界处损伤患者中与更高的失血量、更积极的复苏、更高的残疾率和死亡率相关。早期识别并应用损伤控制技术和复苏措施可能会改善治疗结果。
