Endovascular Versus Open Management of Traumatic Iliac Artery Injuries: Review of the AAST PROOVIT Registry

Noncompressible torso hemorrhage continues to have a high mortality rate. This study aims to review the American Association for the Surgery of Trauma (AAST) PROspective Observational Vascular Injury Treatment (PROOVIT) registry and report the management and outcomes of traumatic iliac injuries based on treatment modality and mechanism of injury (MOI).

A retrospective cohort study was performed of all patients in the PROOVIT registry, suffering traumatic iliac artery injury from March 2013 to January 2024. The primary outcome was in-hospital mortality. Secondary outcomes include resuscitation requirements, time to intervention, length of operation, hospital length of stay (LOS), intensive care unit (ICU) length of stay, postoperative antiplatelet/anticoagulant use, rates of reoperation, amputation, and thrombosis of definitive repair.

Two hundred and thirty-five trauma patients with traumatic iliac artery injuries were identified. Most patients were male, had a blunt MOI, and underwent endovascular repair. Patients with a penetrating MOI were more likely to undergo open repair. Penetrating MOI and open repair were associated with worse clinical presentation, greater resuscitative requirements, and higher reoperation and in-hospital mortality rates. Penetrating injuries managed endovascularly were more likely to be treated with bare metal or covered stents. Blunt injuries were more commonly managed endovascularly via embolization. They also had a shorter interval to intervention compared to patients with a penetrating MOI. Finally, endovascular operative times were shorter than open repair.

Review of the PROOVIT registry reveals that endovascular repair has become the most common treatment modality for traumatic iliac artery injuries. Penetrating MOI and open repair were associated with more severe clinical presentation and greater reoperation and in-hospital mortality rates.