Document Detail


Damage control techniques for common and external iliac artery injuries: have temporary intravascular shunts replaced the need for ligation?
MedLine Citation:
PMID:  20453767     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Chad G Ball; David V Feliciano
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  68     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-10     Completed Date:  2010-05-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1117-20     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia 30303, USA.
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MeSH Terms
Descriptor/Qualifier:
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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