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An observational cohort study of the management and outcomes of vascular trauma
S K Bains1, P A Vlachou, H S Rayt
1Department of Vascular and Endovascular Surgery, University Hospitals of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, UK, LE1 5WW. salenabains@hotmail.com
Insights
Iatrogenic vascular trauma, often from cardiac procedures, is common but has low mortality. Non-cardiac iatrogenic injuries and non-iatrogenic trauma present similar incidence but higher mortality risks.
Area of Science:
- Vascular Surgery
- Trauma Management
- Interventional Cardiology
Background:
- Vascular trauma encompasses both iatrogenic and non-iatrogenic causes.
- Understanding the distinct characteristics and outcomes of each is crucial for effective management.
Purpose of the Study:
- To investigate the etiology, clinical presentation, management strategies, and mortality rates associated with iatrogenic and non-iatrogenic vascular trauma.
- To compare outcomes between different types of vascular trauma within a regional vascular center.
Main Methods:
- A retrospective observational cohort study was conducted.
- Data were collected over a seven-year period (January 2000 to December 2006).
- 182 cases of vascular trauma were analyzed.
Main Results:
- Iatrogenic vascular trauma (73%) was more common than non-iatrogenic (27%), predominantly affecting older adults and younger males, respectively.
- Cardiac interventions were the leading cause of iatrogenic injuries (61%), with increasing use of non-operative treatments.
- Non-iatrogenic trauma had 4% mortality, iatrogenic 7%. Non-cardiac iatrogenic trauma had a significantly higher mortality (17%) compared to cardiac iatrogenic trauma (1.3%).
Conclusions:
- Cardiology-related iatrogenic injuries are the most frequent cause of vascular trauma and have the lowest mortality.
- Non-cardiac iatrogenic vascular trauma, though occurring with similar incidence to penetrating/blunt trauma, carries a substantially higher mortality risk.
Objectives:
To evaluate aetiology, presentation, management and mortality following iatrogenic and non-iatrogenic vascular trauma in a regional vascular centre.
Methods:
Retrospective observational cohort study of patients presenting with vascular trauma during a seven year period between January 2000 and December 2006.
Results:
182 cases of vascular trauma were identified (averaging 26 cases p.a.). The majority (n=132, 73%) were iatrogenic and tended to occur in patients aged >45 years, while 50 (27%) were penetrating/blunt, non-iatrogenic and predominantly occurred in younger males. The majority of iatrogenic vascular injuries (80/132) (61%) followed a cardiac intervention (angiography n=56, angioplasty n=23, pacemaker insertion n=1) and are now increasingly treated by non-operative therapies (thrombin, coils and covered stents). Overall, non-iatrogenic vascular trauma was associated with 4% mortality, compared with 7% following iatrogenic injury. However, while iatrogenic trauma of cardiological origin was associated with a mortality of only 1.3% (1/80), iatrogenic trauma of non-cardiological origin incurred a mortality of 17% (9/52).
Conclusions:
The commonest cause of vascular trauma (and with the lowest mortality rate) was cardiological related iatrogenic injury. However, while non-cardiological iatrogenic injury occurred with the same incidence as penetrating/blunt trauma, it was associated with a fourfold excess mortality.
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