Use of endovascular therapy for peripheral arterial lesions: an analysis of the National Trauma Data Bank from 2007 to 2009.
An endovascular approach is increasingly used for the treatment of peripheral arterial trauma (PAT), but evidence supporting this approach is lacking. The objective of our study was to assess outcomes for endovascular repair (ER) versus operative repair (OR) in PAT.
We used the National Trauma Data Bank from 2007 to 2009 for our analysis, comparing in-hospital morbidity and mortality for all adult patients undergoing ER versus OR for PAT of the upper and lower extremities. Unadjusted and risk-adjusted generalized linear models were performed, with multiple imputation techniques being used to replace missing values.
Of 8,977 patients, 531 (5.9%) underwent ER. Most patients were male (77.1%) and Caucasian (42.6%), with a mean age of 34.7 years (standard deviation: 14.8). ER was performed more commonly for lower- (n = 370, 10.4%) than upper-extremity lesions (n = 161, 3.0%, P < 0.001). Risk-adjusted analysis showed that ER patients had significantly greater injury severity scores (P < 0.001), were more likely to suffer a blunt (vs. penetrating) mechanism of injury (P < 0.001), and were more likely to have multiple comorbid illnesses (P < 0.001) than OR patients. Overall, risk-adjusted complications were less frequent after ER than OR (risk-adjusted OR: 0.79, P = 0.05), whereas in-hospital mortality between the two groups did not differ (risk-adjusted OR: 1.10, P = 0.59). Length of hospital stay was shorter among ER patients (adjusted mean difference: 0.78 days, P < 0.001), whereas length of intensive care unit stay did not differ between the two groups (P = 0.44).
ER appears to be a viable option for patients with PAT. Further research is needed to identify potential subgroups of PAT patients in whom ER may be superior to OR.
Worni, M; Scarborough, JE; Gandhi, M; Pietrobon, R; Shortell, CK
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