Contemporary Management of Axillosubclavian Arterial Injuries Using Data from the AAST PROOVIT Registry

Authors

  • Grahya Guntur University of Maryland
  • Joseph J DuBose USUHS
  • Tiffany K Bee
  • Timothy Fabian
  • Jonathan Morrison
  • David J Skarupa
  • Kenji Inaba
  • Rishi Kundi
  • Thomas Scalea
  • David V Feliciano

DOI:

https://doi.org/10.26676/jevtm.v5i2.201

Abstract

Background: Endovascular repair has emerged as a viable repair option for axillosubclavian arterial injuries in select patients; however, further study of contemporary outcomes is warranted.

Methods: The American Association for the Surgery of Trauma (AAST) PROspective Observational Vascular Injury Treatment (PROOVIT) registry was used to identify patients with axillo-subclavian arterial injuries from 2013 – 2019. Demographics and outcomes were compared between patients undergoing endovascular repair versus open repair.

Results: 167 patients were identified, with intervention required in 107 (64.1%). Among these, 24 patients underwent open damage control surgery (primary amputation = 3, ligation = 17, temporary vascular shunt = 4). The remaining 83 patients (91.6% male; mean age 26.0 ± 16) underwent either endovascular repair (36, 43.4%) or open repair (47, 56.6%). Patients managed with definitive endovascular or open repair had similar demographics and presentation, with the only exception that endovascular repair was more commonly employed for traumatic pseudoaneurysms (p=0.004). Endovascular repair was associated with lower 24-hour transfusion requirements (p=0.012), but otherwise the two groups were similar with regards to in-hospital outcomes.

Conclusion: Endovascular repair is now employed in > 40% of axillo-subclavian arterial injuries undergoing repair at initial operation and is associated with lower 24 hour transfusion requirements, but otherwise outcomes are comparable to open repair.

Downloads

Additional Files

Published

2021-10-03

Issue

Section

Original Article