Original scientific paper in-hospital and post-discharge outcomes with autologous versus prosthetic repair of traumatic abdominal vascular injuries: a 10-year review of the PROOVIT registry.

PURPOSE: Abdominal vascular injury (AVI) often coincides with bowel injury and abdominal contamination. Prosthetic materials may be necessary for vascular reconstruction, but outcomes are poorly understood. We examined outcomes in patients undergoing autologous vs. prosthetic open repair of AVI using a national database. METHODS: This retrospective cohort study (2013-2023) utilized the PROOVIT registry. Patients with abdominal aorta, inferior vena cava, iliac artery/vein, renal vein, or portal vein injuries who underwent open repair and survived ≥72 ​h were included. Univariate and multivariate analyses assessed the association between repair type and in-hospital vascular complications, including re-intervention, amputation, and bowel resection, as well as re-intervention outcomes specifically. Post-discharge data was also reviewed. RESULTS: A total of 142 patients met inclusion criteria, with 124 (87.3%) undergoing autologous repair, primarily as primary repairs with only 5 autologous vein grafts, and 18 (12.7%) undergoing prosthetic repair, including synthetic grafts and bovine pericardial patches, predominantly for arterial injuries (iliac artery, abdominal aorta). In univariate analysis, no significant differences were observed in in-hospital vascular complications, re-intervention, and infection. In adjusted analysis, prosthetic repairs showed a higher risk of in-hospital vascular complications (aOR 5.253, p ​= ​0.017), but comparable risk of re-interventions (aOR 3.046, p ​= ​0.138). Follow-up data (N ​= ​36) revealed 2 complications (5.6%): one infection (autologous) and one thrombosis (prosthetic). Notably, no prosthetic repair required revision due to infection, either in-hospital or during extended follow-up. CONCLUSIONS: Prosthetic repairs may be associated with higher overall complication rates compared to autologous repairs. However, despite the increased complexity of prosthetic repairs and adjustment for injury severity, the autologous cohort did not demonstrate a clear advantage in terms of re-intervention rates. Future studies with more homogeneous cohorts are needed to further confirm or refute the impact of different graft materials on patient outcomes.

Duke Scholars

Author Suresh Kumar Agarwal Jr. Trauma, Acute, and Critical Care Surgery