PC180 Endovascular Stent Repair of Traumatic Superficial Femoral and Popliteal Artery Injuries: An Analysis of the National Trauma Data Bank

Abstract

Despite increasing use of endovascular stent repair of traumatic arterial injuries, such repair of superficial femoral artery (SFA) and popliteal artery (PA) injuries remains uncommon and poorly studied. We describe characteristics and outcomes of trauma patients with SFA and PA injuries repaired using endovascular stenting. This was a retrospective National Trauma Data Bank analysis of trauma patients with a vascular injury isolated to the SFA and PA who underwent endovascular stent repair from 2007 to 2014. The prevalence of SFA and PA injuries was 0.2%, with an increasing trend in the annual use of endovascular stent repair ranging from 1.3% to 3.1% across the study period (P = .004) despite stable injury burdens (Fig 1). Included were 137 patients (81.5% males) with a median age of 31 years (interquartile range [IQR], 22-45 years). The most common comorbidity was smoking (23.4%), and none had pre-existing peripheral vascular disease. Mechanism of injury (MOI) was 57.4% penetrating. On presentation, 5.1% were hypotensive (systolic blood pressure <90 mm Hg), 9.5% were tachycardic (heart rate >120 beats/min), and 4.5% had Glasgow Coma Scale of <9. Median Injury Severity Score was 10 (IQR, 9-17). SFA injury was more common (65.0%) and associated with penetrating MOI (P < .001). PA injury was associated with blunt MOI (P < .001) and with fasciotomy both alone (P = .015) and with concomitant SFA injury (P = .035). Femur fracture and associated vein injury occurred in 35.8% and 7.3% patients, respectively. Median time to stent repair was 5 hours (IQR, 3-11 hours). Fasciotomy was performed in 21.2% patients after a median of 4 hours (IQR, 3-8 hours). The most common in-hospital complication was deep vein thrombosis (11.1%). Overall mortality was 5.8%. Age ≥65 years (P = .025) and Glasgow Coma Scale <9 (P = .045) were associated with mortality on univariate analysis, but only age ≥65 years was independently predictive (odds ratio, 7.5; 95% confidence interval, 1.5-36.4; P = .013). Amputation was performed in 5.1% patients, equally distributed between SFA and PA injury, after a median of 10 days (IQR, 4-32 days). Fasciotomy was significant on both univariate (P = .005) and multivariate analysis (odds ratio, 14.2; 95% confidence interval, 2.3-88.5; P = .005) of amputation, yet time to initial fasciotomy was not associated with amputation (4 vs 3.5 hours; P = .869, Fig 2). Endovascular stent repair of SFA and PA injuries is performed in stable trauma patients with low injury burdens. Death and amputation are infrequent, but age ≥65 years and fasciotomy are significant risk factors, respectively. Despite increasing annual trends, prospective studies are necessary to elucidate the proper algorithm for patient selection in the endovascular management of this patient population.Fig 2Risk factors for (A) overall mortality and (B) amputation. CI, Confidence interval; GCS, Glasgow Coma Scale; ISS, Injury Severity Score; OR, odds ratio.View Large Image Figure ViewerDownload Hi-res image Download (PPT)