Outcome Predictors in Civilian and Iatrogenic Arterial Trauma
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ORIGINAL SCIENTIFIC REPORT
Outcome Predictors in Civilian and Iatrogenic Arterial Trauma Stavros K. Kakkos1 • Minos Tyllianakis2 • Andreas Panagopoulos2 • Zinon Kokkalis2 • Ioanna Lianou2 • Efstratios Koletsis3 • Ioannis Tsolakis1 • Spyros Papadoulas1 • John Gliatis2 • Ioannis Maroulis4 • Panagiotis Kitrou5
Accepted: 6 September 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Our aim was to identify predictors of mortality and limb loss in iatrogenic and civilian arterial trauma. Methods Cases were identified by searching prospectively maintained registries. Multivariable logistic regression was used to identify independent outcome predictors. Results During the study period, 285 patients with arterial trauma were managed with endovascular (n = 20) or open (n = 265) repair. Iatrogenic injuries increased in frequency during the course of the study, from 23.9% during the first decade to 35.9 and 55.7% during the second and third decade, respectively (p \ 0.001). Endovascular management increased in frequency during the course of the study, from 0% during the first decade to 5.1 and 11.1% during the second and third decade, respectively (p = 0.005). Mortality was 9.8%, and limb loss (in cases with injury of the aorta or limb arteries, n = 259) was 6.2%. Independent predictors of mortality included increased age (odds ratio, 95% confidence interval [OR, 95% CI] 1.05 (1.02–1.07), p \ 0.001), blunt trauma (OR [95% CI] 4.8 (1.9–12.2), p = 0.001) and the number of RBC units transfused intraoperatively (OR [95% CI] 1.25 (1.1–1.4), p = 0.001). Independent predictors of limb loss included the first half of the study period (OR [95% CI] 3.9 (1.1–14.1), p = 0.04), lower extremity arterial trauma (vs upper extremity, aortic, common or external iliac artery trauma, OR [95% CI] 8.3 (1.9–35.7), p = 0.004), bone fracture (OR [95% CI] 16.9 (4.7–62.5), p \ 0.001) and the number of RBC units transfused intraoperatively (OR [95% CI] 1.16 (1.02–1.33), p = 0.024). Conclusion Increasingly iatrogenic in cause and managed by endovascular methods, arterial trauma remains a problem associated with significant mortality and limb loss. Identification of unfavourable outcome predictors may help clinicians involved with arterial trauma to escalate the level of care.
& Stavros K. Kakkos [email protected] 1
Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
2
Department of Orthopedic Surgery, University of Patras Medical School, Patras, Greece
3
Department of Cardiothoracic Surgery, University of Patras Medical School, Patras, Greece
4
Department of Surgery, University of Patras Medical School, Patras, Greece
5
Department of Interventional Radiology, University of Patras Medical School, Patras, Greece
Introduction Arterial trauma is an important cause of mortality and limb loss. These are reduced, but not completely abolished with appropriate management. Identification of predictors for unfavourable outcome can potentially optimize patient care. This may be possible by directing ar
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