Boggs Hans K, Tomihama Roger T, Abou-Zamzam Ahmed M, Mukherjee Kaushik, Turay David, Teruya Theodore H, Magtanong Emelyn, Pop Andrew, Kiang Sharon C
Loma Linda University Medical Center, Loma Linda, CA. Department of Surgery, Division of Vascular and Endovascular Surgery.
Loma Linda University Medical Center, Loma Linda, CA. Department of Surgery, Division of Vascular and Endovascular Surgery; Loma Linda Univeristy Medical Center, Loma Linda, CA Department of Radiology, Division of Interventional Radiology.
Ann Vasc Surg. 2022 Feb;79:25-30. doi: 10.1016/j.avsg.2021.07.047. Epub 2021 Oct 14.
In traumatic axillo-subclavian vessel injuries, endovascular repair has been increasingly described, despite ongoing questions regarding infection risk and long-term durability. We sought to compare the clinical and safety outcomes between endovascular and surgical treatment of traumatic axillo-subclavian vessel injuries.
A search query of the prospectively maintained PROOVIT registry for patients older than 18 years of age with a diagnosis of axillary or subclavian vessel injury between 2014-2019 was performed at a Level 1 Trauma Center. Patient demographics, severity of injury, Mangled Extremity Severity Score (MESS), Injury Severity Score (ISS), procedural interventions, complications, and patency outcomes were collected and analyzed.
Twenty-three patients with traumatic axillo-subclavian vessel injuries were included. There were similar rates of penetrating and blunt injuries (48% vs. 52%, respectively). Eighteen patients (78%) underwent intervention: 11 underwent endovascular stenting or diagnostic angiography; 7 underwent open surgical repair. There was similar severity of arterial injuries between the endovascular and open surgical groups: transection (30% vs. 40%, respectively), occlusion (30% vs. 40%, respectively). The open surgical group had worse initial clinical comorbidities: higher ISS scores (17.0 vs 13.5, p = 0.034), higher median MESS scores (6 vs. 3.5, P = 0.001). The technical success for the endovascular group was 100%. The endovascular group had a lower estimated procedural blood loss (27.5 mL vs. 624 mL, P = 0.03). The endovascular arterial group trended toward a shorter length of hospital stay (5.6 days vs. 27.6 days, P = 0.09) and slightly reduced procedural time (191.0 min vs. 223.5 min, P = 0.165). Regarding imaging follow up (average of 60 days post-discharge), 7 patients (54%) underwent surveillance imaging (5 with duplex ultrasound, 2 with computed tomography angiography CTA) that demonstrated 100% patency. Regardless of ISS or MESS scores, at long term clinical follow up (average of 214 days), there were no limb losses, graft infections or vascular complications in either the endovascular or open surgical group.
Endovascular treatment is a viable option for axillo-subclavian vessel injuries. Preliminary results demonstrate that endovascular treatment, when compared to open surgical repair, can have similar rates of technical success and long-term outcomes in patency, infection and vascular complications.
在外伤性腋-锁骨下血管损伤中，尽管感染风险和长期耐用性仍存在问题，但血管内修复的报道日益增多。我们旨在比较外伤性腋-锁骨下血管损伤的血管内治疗与手术治疗的临床及安全性结果。
在一级创伤中心，对前瞻性维护的PROOVIT登记处进行检索，查询2014年至2019年间年龄大于18岁、诊断为腋或锁骨下血管损伤的患者。收集并分析患者的人口统计学资料、损伤严重程度、肢体毁损伤严重程度评分（MESS）、损伤严重程度评分（ISS）、手术干预、并发症及通畅情况结果。
纳入23例外伤性腋-锁骨下血管损伤患者。穿透伤和钝性伤发生率相似（分别为48%和52%）。18例患者（78%）接受了干预：11例行血管内支架置入或诊断性血管造影；7例行开放手术修复。血管内治疗组和开放手术组的动脉损伤严重程度相似：横断伤（分别为30%和40%）、闭塞伤（分别为30%和40%）。开放手术组初始临床合并症更严重：ISS评分更高（17.0比13.5，p = 0.034），中位MESS评分更高（6比3.5，P = 0.001）。血管内治疗组的技术成功率为100%。血管内治疗组估计术中失血量更低（27.5 mL比624 mL，P = 0.03）。血管内动脉治疗组住院时间有缩短趋势（5.6天比27.6天，P = 0.09），手术时间略有缩短（191.0分钟比223.5分钟，P = 0.165）。关于影像学随访（出院后平均60天），7例患者（54%）接受了监测影像学检查（5例采用双功超声，2例采用计算机断层血管造影CTA），显示通畅率为100%。无论ISS或MESS评分如何，在长期临床随访（平均214天）中，血管内治疗组和开放手术组均无肢体丢失、移植物感染或血管并发症。
血管内治疗是腋-锁骨下血管损伤的可行选择。初步结果表明，与开放手术修复相比，血管内治疗在技术成功率、通畅率、感染及血管并发症的长期结果方面相似。
