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Analysis of 185 iliac vessel injuries: risk factors and predictors of outcome
Juan A Asensio1, Patrizio Petrone, Gustavo Roldán
1Department of Surgery, Division of Trauma and Critical Care, Los Angeles County, and University of Southern California Medical Center, Los Angeles 90033, USA. asensio@hsc.usc.edu
Insights
Iliac vascular injuries have high mortality rates, with associated injuries and intraoperative complications significantly increasing risk. The American Association for the Surgery of Trauma Organ Injury Scale grade effectively predicts mortality in these cases.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Emergency Medicine
Background:
- Iliac vascular injuries are associated with a high mortality rate.
- Understanding predictors of survival is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze survival and mortality in patients with iliac vascular injuries.
- To identify independent risk factors for mortality and survival.
- To evaluate the correlation between injury severity and mortality.
Main Methods:
- Retrospective study of 148 patients with 185 iliac vessel injuries over 100 months.
- Analysis of survival and mortality using univariate and logistic regression.
- Assessment of injury severity using the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS).
Main Results:
- Overall survival was 51%. Mortality was 82% in patients with exsanguination.
- Independent risk factors for survival included absence of emergency department thoracotomy, surgical management, and absence of arrhythmia.
- Mortality increased with AAST-OIS grade (Grade III: 35%, Grade IV: 71%, Grade V: 79%).
Conclusions:
- Mortality for iliac vascular injuries remains high.
- Associated injuries and intraoperative complications are significant predictors of mortality.
- The AAST-OIS grade for abdominal vascular injuries correlates with mortality, aiding in risk stratification.
Hypothesis:
Iliac vascular injuries incur high mortality.
Design:
Retrospective 100-month study (January 1, 1992, through April 30, 2000).
Patients:
One hundred forty-eight patients with 185 iliac vessel injuries.
Outcome Measures:
Survival and mortality, analyzed by univariate and logistic regression.
Results:
Admission mean +/- SD systolic blood pressure was 81 +/- 42 mm Hg, mean Revised Trauma Score was 6.0 +/- 2.8, and mean Injury Severity Score was 20.0 +/- 9.5. The mechanism of injury was penetrating in 140 patients (95%) and blunt in 8 (5%). The mean estimated blood loss was 6246 +/- 6174 mL. Of the 185 injured vessels, 71 (99%) of 72 iliac arteries were repaired, 101 (89%) of 113 iliac veins were ligated, and 12 (11%) of 113 iliac veins were repaired. Overall survival was 51% (76/148). Mortality was 82% (49/72) in patients with exsanguination. Survival by vessel: iliac artery, 57% (20/35); iliac vein, 55% (42/76); and iliac artery and vein, 38% (14/37). Significant predictors of outcome were thoracotomy in the emergency department, associated aortic injury, inferior vena cava injuries, iliac artery and vein injury, intraoperative arrhythmia, and intraoperative coagulopathy. On logistic regression, independent risk factors for survival were absence of thoracotomy in the emergency department, surgical management, and arrhythmia. Mortality by grade on the Organ Injury Scale of the American Association for the Surgery of Trauma (AAST-OIS) was as follows: grade III, 35% (33/95); grade IV, 71% (24/34); and grade V, 79% (15/19).
Conclusions:
Mortality remains high. Associated vessel injuries and intraoperative complications predict mortality. AAST-OIS grade for abdominal vascular injuries correlates well with mortality.
