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Published on: October 20, 2017
Long-Term Outcomes of Traumatic Neck Vascular Injury Repairs: A Prospective Observational Vascular Injury Treatment
Negar Nekooei1, Christine Bent1, Danielle Brabender1
1Department of Acute Care Surgery, Los Angeles General Medical Center, University of Southern California, Los Angeles, California.
Introduction:
Outcomes following cervical arterial repair (CAR) in trauma have been studied, but most reports focus on inpatient complications with limited insight into postdischarge events. This study evaluates long-term outcomes using follow-up data from the Prospective Observational Vascular Injury Treatment (PROOVIT) registry.
Methods:
This retrospective case-control study (2012-2023) queried PROOVIT for patients with cervical arterial trauma who underwent endovascular or open repair. The PROOVIT postdischarge module was queried for patients with available follow-up. Patients' data and CAR-related vascular complications (VCs) were collected. VCs were assessed during hospitalization (VCIHs) and postdischarge (VCPDs), and characteristics were compared between cohorts with and without complications. VC rates were also analyzed by intervention type.
Results:
Among 1657 patients, 140 (9%) underwent CAR, with most sustaining penetrating trauma (67%). Interventions included endovascular repair (49%), ligation/shunt (19%), and arterial repair (32%). VCIHs occurred in 27% of patients. Of the 120 discharged patients, follow-up data were available for 40 (36%). VCPDs developed in 7% of those with prior VCIHs, compared to 27% in those without (P = 0.2). VCPD rates by intervention type were: endovascular 12.5%, ligation/shunt 33%, and arterial repair 30% (P = 0.344). Predictors of VCIHs included higher Injury Severity Score, lower Glasgow Coma Scale, and internal carotid vessel injury. Predictors of VCPDs were lack of postoperative platelet transfusion and longer length of stay in intensive care unit during the index hospitalization. Complication types included reintervention, technical failure of the repair, pseudoaneurysm, and infection.
Conclusions:
CAR-related VCs persist postdischarge, with many occurring in patients previously complication-free. These findings underscore the need for consistent long-term follow-up in vascular trauma care.