Yu Qian, Lionberg Alex, Zane Kylie, Ungchusri Ethan, Du Jonathan, Nijhawan Karan, Clarey Austin, Navuluri Rakesh, Ahmed Osman, Prakash Priya, Leef Jeffrey, Funaki Brian
Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
Department of Surgery, University of Chicago Medical Center, Chicago, IL, 60637, USA.
CVIR Endovasc. 2023 Oct 16;6(1):47. doi: 10.1186/s42155-023-00396-5.
To assess the effectiveness of trans-arterial vascular interventions in treatment of civilian gunshot wounds (GSW).
A retrospective review was performed at a level-1 trauma center to include 46 consecutive adults admitted due to GSW related hemorrhage and treated with endovascular interventions from July 2018 to July 2022. Patient demographics and procedural metrics were retrieved. Primary outcomes of interest include technical success and in-hospital mortality. Factors of mortality were assessed using a logistic regression model.
Twenty-one patients were brought to the endovascular suite directly (endovascular group) from the trauma bay and 25 patients after treatment in the operating room (OR group). The OR group had higher hemodynamic instability (48.0% vs 19.0%, p = 0.040), lower hemoglobin (12.9 vs 10.1, p = 0.001) and platelet counts (235.2 vs 155.1, p = 0.003), and worse Acute Physiology and Chronic Health Evaluation (APACHE) score (4.1 vs 10.2, p < 0.0001) at the time of initial presentation. Technical success was achieved in all 40 cases in which targeted embolization was attempted (100%). Empiric embolization was performed in 6/46 (13.0%) patients based on computed tomographic angiogram (CTA) and operative findings. Stent-grafts were placed in 3 patients for subclavian artery injuries. Availability of pre-intervention CTA was associated with shorter fluoroscopy time (19.8 ± 12.1 vs 30.7 ± 18.6 min, p = 0.030). A total of 41 patients were discharged in stable condition (89.1%). Hollow organ injury was associated with mortality (p = 0.039).
Endovascular embolization and stenting were effective in managing hemorrhage due to GSW in a carefully selected population. Hollow organ injury was a statistically significant predictor of mortality. Pre-intervention CTA enabled targeted, shorter and equally effective procedures.
评估经动脉血管介入治疗平民枪伤（GSW）的有效性。
在一家一级创伤中心进行回顾性研究，纳入2018年7月至2022年7月期间因GSW相关出血入院并接受血管内介入治疗的46例连续成年患者。收集患者人口统计学和手术指标。主要关注的结果包括技术成功率和院内死亡率。使用逻辑回归模型评估死亡因素。
21例患者直接从创伤病房被送至血管内治疗室（血管内治疗组），25例患者在手术室治疗后（手术室组）。手术室组在初次就诊时血流动力学不稳定程度更高（48.0%对19.0%，p = 0.040），血红蛋白水平更低（12.9对10.1，p = 0.001），血小板计数更低（235.2对155.1，p = 0.003），急性生理与慢性健康状况评估（APACHE）评分更差（4.1对10.2，p < 0.0001）。在所有40例尝试进行靶向栓塞的病例中均取得技术成功（成功率100%）。基于计算机断层血管造影（CTA）和手术结果，6/46（13.0%）例患者进行了经验性栓塞。3例患者因锁骨下动脉损伤置入了覆膜支架。干预前CTA的可用性与透视时间缩短相关（19.8±12.1对30.7±18.6分钟，p = 0.030）。共有41例患者病情稳定出院（89.1%）。中空器官损伤与死亡率相关（p = 0.039）。
在经过精心挑选的人群中，血管内栓塞和支架置入术在处理GSW引起的出血方面有效。中空器官损伤是死亡率的统计学显著预测因素。干预前CTA可实现靶向、更短且同样有效的手术。
