From the Department of Vascular Surgery (E.R.F., J.S., J.J.D.), David Grant USAF Medical Center, Travis AFB, Fairfield, California; Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery (B.C.B.), Baylor College of Medicine, Houston, Texas; Department of Vascular Surgery (M.N.L.), University of California Davis Medical Center, Sacramento; Clinical Investigations Facility, David Grant USAF Medical Center (K.G.), Travis AFB, Fairfield, California; Department of Surgery (T.C.F.), University of Tennessee-Memphis, Memphis, Tennessee; Department of Surgery (J.B.H.), University of Texas Health Sciences Center-Houston, Houston, Texas; R Adams Cowley Shock Trauma Center (T.S.), University of Maryland, Baltimore, Maryland; Department of Surgery (D.S.), University of Florida, Jacksonville, Florida; Department of Surgery (K.I.), Department of Surgery (K.I.), Los Angeles County + University of Southern California Medical Center, Los Angeles, California; Department of Surgery (N.P.), East Carolina Medical Center, Benson, North Carolina; and Department of Surgery (T.E.R.), United Services Uniformed School of Health Sciences, Bethesda, Maryland.
J Trauma Acute Care Surg. 2018 Mar;84(3):411-417. doi: 10.1097/TA.0000000000001776.
Vascular trauma data have been submitted to the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Trial (PROOVIT) database since 2013. We present data to describe current use of endovascular surgery in vascular trauma.
Registry data from March 2013 to December 2016 were reviewed. All trauma patients who had an injury to a named artery, except the forearm and lower leg, were included. Arteries were grouped into anatomic regions and by compressible and noncompressible region for analysis. This review focused on patients with noncompressible transection, partial transection, or flow-limiting defect injuries. Bivariate and multivariate analyses were used to assess the relationships between study variables.
One thousand one hundred forty-three patients from 22 institutions were included. Median age was 32 years (interquartile range, 23-48) and 76% (n = 871) were male. Mechanisms of injury were 49% (n = 561) blunt, 41% (n = 464) penetrating, and 1.8% (n = 21) of mixed aetiology. Gunshot wounds accounted for 73% (n = 341) of all penetrating injuries. Endovascular techniques were used least often in limb trauma and most commonly in patients with blunt injuries to more than one region. Penetrating wounds to any region were preferentially treated with open surgery (74%, n = 341/459). The most common indication for endovascular treatment was blunt noncompressible torso injuries. These patients had higher Injury Severity Scores and longer associated hospital stays, but required less packed red blood cells, and had lower in hospital mortality than those treated with open surgery. On multivariate analysis, admission low hemoglobin concentration and abdominal injury were independent predictors of mortality.
Our review of PROOVIT registry data demonstrates a high utilization of endovascular therapy among severely injured blunt trauma patients primarily with noncompressible torso hemorrhage. This is associated with a decreased need for blood transfusion and improved survival despite longer length of stay.
Therapeutic/care management, level III.
自 2013 年以来，血管创伤数据已提交给美国创伤外科学协会前瞻性观察性血管损伤试验 (PROOVIT) 数据库。我们呈现的数据旨在描述血管创伤中血管内手术的当前应用。
回顾了 2013 年 3 月至 2016 年 12 月期间的登记数据。所有受伤动脉的创伤患者（前臂和小腿除外）均被纳入研究。将动脉分为解剖区域，并根据可压缩和不可压缩区域进行分析。本研究重点关注非压缩性横断伤、部分横断伤或血流受限性损伤的患者。使用二变量和多变量分析评估研究变量之间的关系。
22 家机构的 1143 名患者纳入研究。中位年龄为 32 岁（四分位间距 23-48 岁），76%（n=871）为男性。损伤机制为 49%（n=561）为钝性，41%（n=464）为穿透性，1.8%（n=21）为混合病因。枪伤占所有穿透性损伤的 73%（n=341）。血管内技术在肢体创伤中使用最少，在多个区域钝性损伤的患者中最常用。任何部位的穿透性伤口首选开放手术治疗（74%，n=341/459）。血管内治疗的最常见指征是钝性非压缩性躯干损伤。这些患者的损伤严重程度评分较高，相关住院时间较长，但需要的红细胞浓缩物较少，院内死亡率低于开放手术治疗患者。多变量分析显示，入院时低血红蛋白浓度和腹部损伤是死亡的独立预测因素。
我们对 PROOVIT 登记数据的回顾表明，严重钝性创伤患者，尤其是非压缩性躯干出血患者，广泛应用血管内治疗。这与输血需求减少和生存率提高有关，尽管住院时间延长。
治疗/护理管理，III 级。
