Kim Maru, Firek Matthew, Coimbra Bruno C, Allison-Aipa Timothy, Zakhary Bishoy, Kwon Junsik, Coimbra Raul
Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA; Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA.
Ann Vasc Surg. 2025 Mar;112:239-245. doi: 10.1016/j.avsg.2024.12.055. Epub 2024 Dec 26.
The management of patients with subclavian artery injury is rapidly evolving from an open to an endovascular approach. We aim to present an analysis of management and a comparison of outcomes according to the type of approach used to treat these challenging injuries.
Adult patients with subclavian arterial injuries were abstracted from the National Inpatient Sample database from 2012-2014 and 2016-2021. Patients were divided according to the type of management, which was endovascular management (EM; stent placement) or open surgery (OS), and clinical outcomes were compared. A multivariable logistic regression model was used to determine risk factors associated with in-hospital mortality.
A total of 1200 cases were analyzed. The EM and OS groups had similar baseline characteristics, including age, sex, All Patient Refined Diagnosis-Related Groups severity of illness and risk of mortality scores, and Charlson Comorbidity Scores. The presence of shock on admission was similar between groups (EM: 23.1% vs. OS: 34.2%; P = 0.115). Median injury severity score was higher in the EM group but with a lower mortality rate (5.5% vs. 14.8%, P = 0.045) than OS. Additionally, EM was associated with a lower fasciotomy rate (P = 0.018). Hemorrhagic shock on presentation (odds ratio: 3.72) was associated with a marked increase in the odds of in-hospital mortality, while EM was associated with a 67% decrease (odds ratio: 0.33).
EM is associated with significantly better outcomes, including lower odds of in-hospital mortality and a decreased need for fasciotomy. Currently, EM is a feasible option in the management of subclavian arterial injuries.
锁骨下动脉损伤患者的治疗正迅速从开放手术方式向血管腔内治疗方式转变。我们旨在根据治疗这些具有挑战性损伤所采用的方法类型，对治疗情况进行分析并比较治疗结果。
从2012 - 2014年和2016 - 2021年的全国住院患者样本数据库中提取成年锁骨下动脉损伤患者。根据治疗方式将患者分为血管腔内治疗（EM；支架置入）或开放手术（OS），并比较临床结果。使用多变量逻辑回归模型确定与院内死亡率相关的危险因素。
共分析了1200例病例。EM组和OS组具有相似的基线特征，包括年龄、性别、所有患者精细诊断相关组疾病严重程度和死亡风险评分以及查尔森合并症评分。两组入院时休克的发生率相似（EM组：23.1% 对OS组：34.2%；P = 0.115）。EM组的损伤严重程度评分中位数较高，但死亡率低于OS组（5.5% 对14.8%，P = 0.045）。此外，EM与较低的筋膜切开率相关（P = 0.018）。就诊时发生出血性休克（比值比：3.72）与院内死亡几率显著增加相关，而EM与降低67%（比值比：0.33）相关。
EM与明显更好的结果相关，包括较低的院内死亡几率和减少筋膜切开的需求。目前，EM是治疗锁骨下动脉损伤的一种可行选择。
