Adverse outcome of nonoperative management of intimal injuries caused by penetrating trauma

Abstract

Purpose: The objective of this study was to determine adverse outcomes associated with the nonoperative management of intimal injuries.Methods: A five-year retrospective review of 118 patients admitted with soft signs of vascular injury to two level I trauma centers was conducted. All injuries evaluated were isolated penetrating injuries. The number of major arteries at risk were 16 axillary, 31 brachial, 36 common femoral, 22 superficial femoral, and 13 deep femoral. Twenty-three angiographic abnormalities were identified in 23 limbs. Seven injuries were categorized as “minor” intimal flaps and treated with observation alone. The remainder were explored during operation.Results: During the follow-up period, six of the seven patients treated without operation returned to either the outpatient clinic or emergency department with acute onset of pain or paresthesia in the previously injured limb. The following abnormalities were identified with angiography: one axillary artery thrombosis, one brachial artery pseudoaneurysm, two common femoral thromboses, two superficial femoral artery/superficial femoral vein fistulas, and one deep femoral artery pseudoaneurysm. All the abnormalities were repaired with operation.Conclusion: The benign nature of intimal injury identified with angiography may be overemphasized. The results of long-term follow-up in patients with this type of injury must be reviewed before “observation alone” can be recommended as standard treatment.