Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA.
Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA.
Ann Vasc Surg. 2021 Jan;70:87-94. doi: 10.1016/j.avsg.2020.05.007. Epub 2020 May 15.
There is preliminary evidence that vascular surgeons are increasingly relied on nationally to assist with the management of lower extremity vascular trauma. Current trauma center verification, however, does not require any level of vascular surgery coverage. We sought to assess practice patterns regarding vascular surgery consultation and temporal trends in the surgical management of these patients.
A retrospective analysis was performed on all patients who underwent surgical repair for vascular trauma of the lower extremity at a single, academic, public hospital from 2011 to 2018. Demographic data and procedural data were collected. Patients were assigned to a vascular surgery (VS) or nonvascular surgery (NV) group. The primary outcome measure was the rate of VS consultation. Secondary outcome measures included 30-day mortality, length-of-stay, and limb salvage.
One hundred eighty patients were identified (77 VS group, 103 NV group). There was an increase in the proportion of repairs done by VS from 2011 to 2018 (P < 0.05). There were significant management differences between the 2 groups, with vascular surgeons more likely to perform primary end-to-end anastomosis for both arterial (21.33% vs. 6.90%) and venous (19.15% vs. 5.26%) injuries (both P < 0.05). Patients in the VS group were less likely to have balloon embolectomy, fasciotomy, or intravascular shunting than the NV group (all P < 0.05). There were no significant differences in mortality (5.35% vs. 4.85%), length-of-stay (15.05 vs. 18.38 days), or limb salvage (94.81% vs. 95.15%).
Lower extremity vascular trauma is increasingly managed by vascular surgeons. Furthermore, vascular surgeons are more selective in the use of potentially unnecessary adjunctive maneuvers. Current accreditation guidelines should be revisited to mandate vascular surgery coverage in trauma centers that frequently treat this patient population.
有初步证据表明，血管外科医生在全国范围内越来越多地被依赖来协助处理下肢血管外伤。然而，目前的创伤中心验证并不要求任何级别的血管外科覆盖。我们试图评估关于血管外科咨询的实践模式以及这些患者手术管理的时间趋势。
对 2011 年至 2018 年期间在一家单一的学术性公立医院接受下肢血管创伤手术修复的所有患者进行回顾性分析。收集人口统计学数据和手术数据。患者分为血管外科 (VS) 或非血管外科 (NV) 组。主要观察指标是 VS 咨询率。次要观察指标包括 30 天死亡率、住院时间和肢体存活率。
确定了 180 例患者（77 例 VS 组，103 例 NV 组）。从 2011 年到 2018 年，由 VS 进行修复的比例增加（P < 0.05）。两组之间存在显著的管理差异，血管外科医生更有可能对动脉（21.33%比 6.90%）和静脉（19.15%比 5.26%）损伤进行直接端端吻合（均 P < 0.05）。与 NV 组相比，VS 组患者接受球囊动脉取栓术、筋膜切开术或血管内分流术的可能性较小（均 P < 0.05）。两组之间的死亡率（5.35%比 4.85%）、住院时间（15.05 比 18.38 天）或肢体存活率（94.81%比 95.15%）无显著差异。
下肢血管外伤越来越多地由血管外科医生处理。此外，血管外科医生在使用潜在不必要的辅助操作时更具选择性。目前的认证指南应重新审查，以要求经常治疗这类患者人群的创伤中心配备血管外科覆盖。
