Management and outcomes of blunt common and external iliac arterial injuries

Donald G. Harris, Charles B. Drucker, Megan L. Brenner, Mayur Narayan, Rajabrata Sarkar, Thomas M. Scalea, Robert S. Crawford

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective Blunt iliac arterial injuries (BIAI) require complex management but are rare and poorly studied. We investigated the presentation, management, and outcomes of patients with blunt common or external iliac arterial injuries. Methods We identified and reviewed 112 patients with BIAI admitted between 2000 and 2011 at a Level I trauma center. Patients with common/external iliac artery injuries (CE group) were primarily analyzed, with patients with injuries of the internal iliac artery or its major branches (IB group) included for comparison of pelvic arterial trauma. Results Twenty-four patients had CE and 88 had IB injuries. Mean ages (45 ± 19 years) and gender (86% male) were similar between groups. The mean injury severity score was 40 ± 14 (CE, 36 ± 15; IB, 40 ± 14; P =.19), indicating severe trauma. Twenty (83%) of the CE patients presented with signs of leg malperfusion. Admission factors associated with CE injury were crush mechanism of injury (37% vs 17%; P =.03) and pelvic soft tissue trauma (50% vs 15%; P <.01). The CE group had higher early mortality rates, both within 3 hours of admission (50% vs 19%; P =.04) and prior to iliac intervention (42% vs 3%; P <.01). Among those surviving to management, CE patients were more likely to undergo open repair or revascularization (68% vs 3%; P <.01) and had a higher rate of leg amputation (50% vs 6%; P <.01), with 8/12 (67%) culminating in hemipelvectomy. Risk factors for amputation included leg malperfusion, high-grade pelvic fractures, pelvic soft tissue trauma, and increasing leg injury severity. Overall mortality was 40%, and was similar between the injury groups. Among CE patients, need for amputation, pelvic fractures, and wounds were associated with inpatient mortality. Conclusions This is the largest series to date of blunt CE injuries and demonstrates distinct clinical features and outcomes for these patients. They have high risk for early death and proximal leg amputation. CE injury is specifically associated with serious open pelvic soft tissue injury, which, along with high-grade pelvic fractures, is a risk factor for amputation and death. On-demand emergent endovascular intervention may play an important role in improving management of these complex injuries.

Original languageEnglish (US)
Pages (from-to)180-185
Number of pages6
JournalJournal of Vascular Surgery
Volume59
Issue number1
DOIs
StatePublished - Jan 1 2014

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Wounds and Injuries
Amputation
Leg
Iliac Artery
Mortality
Leg Injuries
Hemipelvectomy
Soft Tissue Injuries
Nonpenetrating Wounds
Injury Severity Score
Trauma Centers
Inpatients

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Harris, D. G., Drucker, C. B., Brenner, M. L., Narayan, M., Sarkar, R., Scalea, T. M., & Crawford, R. S. (2014). Management and outcomes of blunt common and external iliac arterial injuries. Journal of Vascular Surgery, 59(1), 180-185. https://doi.org/10.1016/j.jvs.2013.07.107

Management and outcomes of blunt common and external iliac arterial injuries. / Harris, Donald G.; Drucker, Charles B.; Brenner, Megan L.; Narayan, Mayur; Sarkar, Rajabrata; Scalea, Thomas M.; Crawford, Robert S.

In: Journal of Vascular Surgery, Vol. 59, No. 1, 01.01.2014, p. 180-185.

Research output: Contribution to journalArticle

Harris, DG, Drucker, CB, Brenner, ML, Narayan, M, Sarkar, R, Scalea, TM & Crawford, RS 2014, 'Management and outcomes of blunt common and external iliac arterial injuries', Journal of Vascular Surgery, vol. 59, no. 1, pp. 180-185. https://doi.org/10.1016/j.jvs.2013.07.107
Harris, Donald G. ; Drucker, Charles B. ; Brenner, Megan L. ; Narayan, Mayur ; Sarkar, Rajabrata ; Scalea, Thomas M. ; Crawford, Robert S. / Management and outcomes of blunt common and external iliac arterial injuries. In: Journal of Vascular Surgery. 2014 ; Vol. 59, No. 1. pp. 180-185.
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abstract = "Objective Blunt iliac arterial injuries (BIAI) require complex management but are rare and poorly studied. We investigated the presentation, management, and outcomes of patients with blunt common or external iliac arterial injuries. Methods We identified and reviewed 112 patients with BIAI admitted between 2000 and 2011 at a Level I trauma center. Patients with common/external iliac artery injuries (CE group) were primarily analyzed, with patients with injuries of the internal iliac artery or its major branches (IB group) included for comparison of pelvic arterial trauma. Results Twenty-four patients had CE and 88 had IB injuries. Mean ages (45 ± 19 years) and gender (86{\%} male) were similar between groups. The mean injury severity score was 40 ± 14 (CE, 36 ± 15; IB, 40 ± 14; P =.19), indicating severe trauma. Twenty (83{\%}) of the CE patients presented with signs of leg malperfusion. Admission factors associated with CE injury were crush mechanism of injury (37{\%} vs 17{\%}; P =.03) and pelvic soft tissue trauma (50{\%} vs 15{\%}; P <.01). The CE group had higher early mortality rates, both within 3 hours of admission (50{\%} vs 19{\%}; P =.04) and prior to iliac intervention (42{\%} vs 3{\%}; P <.01). Among those surviving to management, CE patients were more likely to undergo open repair or revascularization (68{\%} vs 3{\%}; P <.01) and had a higher rate of leg amputation (50{\%} vs 6{\%}; P <.01), with 8/12 (67{\%}) culminating in hemipelvectomy. Risk factors for amputation included leg malperfusion, high-grade pelvic fractures, pelvic soft tissue trauma, and increasing leg injury severity. Overall mortality was 40{\%}, and was similar between the injury groups. Among CE patients, need for amputation, pelvic fractures, and wounds were associated with inpatient mortality. Conclusions This is the largest series to date of blunt CE injuries and demonstrates distinct clinical features and outcomes for these patients. They have high risk for early death and proximal leg amputation. CE injury is specifically associated with serious open pelvic soft tissue injury, which, along with high-grade pelvic fractures, is a risk factor for amputation and death. On-demand emergent endovascular intervention may play an important role in improving management of these complex injuries.",
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N2 - Objective Blunt iliac arterial injuries (BIAI) require complex management but are rare and poorly studied. We investigated the presentation, management, and outcomes of patients with blunt common or external iliac arterial injuries. Methods We identified and reviewed 112 patients with BIAI admitted between 2000 and 2011 at a Level I trauma center. Patients with common/external iliac artery injuries (CE group) were primarily analyzed, with patients with injuries of the internal iliac artery or its major branches (IB group) included for comparison of pelvic arterial trauma. Results Twenty-four patients had CE and 88 had IB injuries. Mean ages (45 ± 19 years) and gender (86% male) were similar between groups. The mean injury severity score was 40 ± 14 (CE, 36 ± 15; IB, 40 ± 14; P =.19), indicating severe trauma. Twenty (83%) of the CE patients presented with signs of leg malperfusion. Admission factors associated with CE injury were crush mechanism of injury (37% vs 17%; P =.03) and pelvic soft tissue trauma (50% vs 15%; P <.01). The CE group had higher early mortality rates, both within 3 hours of admission (50% vs 19%; P =.04) and prior to iliac intervention (42% vs 3%; P <.01). Among those surviving to management, CE patients were more likely to undergo open repair or revascularization (68% vs 3%; P <.01) and had a higher rate of leg amputation (50% vs 6%; P <.01), with 8/12 (67%) culminating in hemipelvectomy. Risk factors for amputation included leg malperfusion, high-grade pelvic fractures, pelvic soft tissue trauma, and increasing leg injury severity. Overall mortality was 40%, and was similar between the injury groups. Among CE patients, need for amputation, pelvic fractures, and wounds were associated with inpatient mortality. Conclusions This is the largest series to date of blunt CE injuries and demonstrates distinct clinical features and outcomes for these patients. They have high risk for early death and proximal leg amputation. CE injury is specifically associated with serious open pelvic soft tissue injury, which, along with high-grade pelvic fractures, is a risk factor for amputation and death. On-demand emergent endovascular intervention may play an important role in improving management of these complex injuries.

AB - Objective Blunt iliac arterial injuries (BIAI) require complex management but are rare and poorly studied. We investigated the presentation, management, and outcomes of patients with blunt common or external iliac arterial injuries. Methods We identified and reviewed 112 patients with BIAI admitted between 2000 and 2011 at a Level I trauma center. Patients with common/external iliac artery injuries (CE group) were primarily analyzed, with patients with injuries of the internal iliac artery or its major branches (IB group) included for comparison of pelvic arterial trauma. Results Twenty-four patients had CE and 88 had IB injuries. Mean ages (45 ± 19 years) and gender (86% male) were similar between groups. The mean injury severity score was 40 ± 14 (CE, 36 ± 15; IB, 40 ± 14; P =.19), indicating severe trauma. Twenty (83%) of the CE patients presented with signs of leg malperfusion. Admission factors associated with CE injury were crush mechanism of injury (37% vs 17%; P =.03) and pelvic soft tissue trauma (50% vs 15%; P <.01). The CE group had higher early mortality rates, both within 3 hours of admission (50% vs 19%; P =.04) and prior to iliac intervention (42% vs 3%; P <.01). Among those surviving to management, CE patients were more likely to undergo open repair or revascularization (68% vs 3%; P <.01) and had a higher rate of leg amputation (50% vs 6%; P <.01), with 8/12 (67%) culminating in hemipelvectomy. Risk factors for amputation included leg malperfusion, high-grade pelvic fractures, pelvic soft tissue trauma, and increasing leg injury severity. Overall mortality was 40%, and was similar between the injury groups. Among CE patients, need for amputation, pelvic fractures, and wounds were associated with inpatient mortality. Conclusions This is the largest series to date of blunt CE injuries and demonstrates distinct clinical features and outcomes for these patients. They have high risk for early death and proximal leg amputation. CE injury is specifically associated with serious open pelvic soft tissue injury, which, along with high-grade pelvic fractures, is a risk factor for amputation and death. On-demand emergent endovascular intervention may play an important role in improving management of these complex injuries.

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