腸骨血管損傷に対する血管内治療と開腹手術アプローチの全国データベース評価

Iliac vessel injuries are linked to a high mortality rate in trauma surgery. Endovascular repair of these injuries has gained recognition as a less invasive alternative, with possibly better outcomes.

A retrospective analysis of the National Trauma Data Bank was performed of all iliac vessel injuries for the year 2022. The endpoint was the in-hospital mortality rate. Secondary outcomes included in-hospital and critical care unit lengths of stay, complications, and major amputation rates.

Out of a total of 2,300 patients with iliac vessel injuries, 74.4% were male with an average age of 46 years (±20.1 years). The majority (68.9%) had blunt trauma, while 31.1% had penetrating trauma. Treatment modalities included endovascular procedures (41.9%), open surgery (25.1%), and non-operative management (33.0%). Endovascular treatment was associated with lower mortality rates (18%) compared to open surgery (26%) and non-operative management (19.4%) (p<0.05). Patients undergoing endovascular interventions were older and had higher Injury Severity Scores (p<0.05). Complex iliac injuries had higher rates of complications and mortality compared to isolated injuries (p<0.05). Factors associated with increased mortality included age over 55 (OR 2.33), higher Injury Severity Scores (OR 1.07), and penetrating mechanism of injury (OR 2.82) (p<0.001). Endovascular intervention was associated with a significantly lower odds of in-hospital mortality compared with open vascular treatment in penetrating trauma (adjusted OR 0.067, p < 0.05).

Our results underscore the increasing role of endovascular intervention in managing iliac trauma and suggest a mortality benefit in specific injury pattern scenarios.