| Damage control techniques for common and external iliac artery injuries: have temporary intravascular shunts replaced the need for ligation? | |
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MedLine Citation:
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PMID: 20453767 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Trauma to the common or external iliac arteries has a mortality rate of 24% to 60%. "Damage control" options for these severely injured vessels are either ligation or temporary intravascular shunts (TIVSs). Complications of ligation include a 50% amputation rate and up to 90% mortality. The primary goal of this study was to identify the consequences of using ligation versus TIVS for common or external iliac artery injuries in damage control scenarios. METHODS: All patients with injuries to an iliac artery (1995-2008) at a Level I trauma center were reviewed. Demographics and outcomes were analyzed using standard statistical methodology. RESULTS: Iliac artery injuries were present in 88 patients (71 external and 17 common; 72% penetrating; median Injury Severity Score, 25; mean hospital stay, 28 days). Most nonsurvivors (73%) died of refractory shock within the first 24 hours after presenting with hemodynamic instability (66%). Ligation was required in one (6%) common and 14 (20%) external iliac arteries. TIVS was used in two (12%) common and five (7%) external iliac arteries. Patients requiring ligation (1995-2005) or TIVS (2005-2008) for their common or external iliac arteries had similar demographics and injuries (p > 0.05). Compared with patients who underwent ligation, patients receiving TIVS required fewer amputations (47% vs. 0%) and fasciotomies (93% vs. 43%; p < 0.05). Mortality in the ligation group was 73%, versus 43% in the TIVS cohort. CONCLUSIONS: TIVSs have replaced ligation as the primary damage control procedure for injuries to common and external iliac arteries. As a result, the high incidence of subsequent amputation has been virtually eliminated. With increased TIVS experience, an improvement in survival is likely. |
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Authors:
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Chad G Ball; David V Feliciano |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The Journal of trauma Volume: 68 ISSN: 1529-8809 ISO Abbreviation: J Trauma Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-10 Completed Date: 2010-05-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
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Languages: eng Pagination: 1117-20 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia 30303, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Amputation / statistics & numerical data Blood Vessel Prosthesis Implantation / instrumentation, methods*, trends Female Georgia / epidemiology Health Services Needs and Demand Humans Iliac Artery* / injuries, surgery Injury Severity Score Length of Stay / statistics & numerical data Ligation / methods*, statistics & numerical data Male Medical Audit Patient Selection Retrospective Studies Statistics, Nonparametric Survival Rate Trauma Centers Traumatology / methods, trends Treatment Outcome Wounds, Nonpenetrating / epidemiology, surgery* Wounds, Penetrating / epidemiology, surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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