Increasing use of endovascular therapy in acute arterial injuries: analysis of the National Trauma Data Bank

Brian C Reuben, Matthew G Whitten, Mark Sarfati, Larry W Kraiss
Journal of Vascular Surgery 2007, 46 (6): 1222-1226

OBJECTIVE: The application of endovascular technology for the emergency treatment of traumatic vascular injuries is a new frontier. This study examines recent nationwide use of endovascular therapy in acute arterial traumatic injuries.

METHODS: This retrospective study used the National Trauma Data Bank (NTDB). Cases with a diagnosis of arterial vascular injury were identified according to the International Classification of Diseases, Ninth Revision, Clinical Modification, and procedure codes for endovascular therapy were selected. A descriptive analysis and multiple regressions were performed to identify variables predictive of outcomes.

RESULTS: From 1994 to 2003, 12,732 arterial injuries were identified. Between 1997 (when the first endovascular repair was recorded in the NTDB) and 2003, 7286 open arterial repairs and 281 endovascular repairs were recorded for an overall utilization rate for endovascular procedures of 3.7%. The yearly number of endovascular procedures registered in the NTDB increased 27-fold, from four in 1997 to 107 in 2003. Use of stents substantially increased from 12 in 2000 to 30 in 2003; endograft use increased from one in 2000 to 37 in 2003. Nearly equal numbers of blunt (n = 134) and penetrating (n = 111) injuries were treated. The injury severity score (median, interquartile range [IRQ]) was significantly lower in patients who underwent an endovascular procedure at 13 (IRQ, 9 to 26) for trauma vs patients requiring an open procedure at 20 (IRQ, 10 to 34; P < .001), a finding corroborated by the lower number of associated injuries in patients undergoing endovascular repair (8.7 +/- 7.2 vs 13.0 +/- 16.1, P < .001). Using multivariable regression to control for differences in injury severity score and associated injuries, mortality was significantly lower for patients undergoing endovascular procedures (odds ratio, 0.18; P = .029) including those with an arterial injury of the torso or head and neck (odds ratio, 0.51, P = .007). Total length of hospital stay also tended to be lower for patients undergoing endovascular procedures by 18% (P = .064).

CONCLUSION: The use of endovascular therapy in the setting of acute trauma is increasing in a dramatic fashion and is being used to treat a wide variety of vessels injured by blunt and penetrating mechanisms. Endovascular therapy appears to be particularly suitable for patients who present with less severe injuries and greater hemodynamic stability. These preliminary data suggest that the use of endovascular therapy for acute traumatic arterial injuries yields shorter lengths of stay and improved survival.

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