Traumatic arterial injuries: endovascular management

Abstract

Objective The purpose of this study is to evaluate the efficacy of endovascular management of traumatic arterial injuries. Patients and methods We conducted our prospective study at Vascular Surgery Department and Radiology Department, Zagazig University Hospitals, Egypt, and intervention Radiology Department, Alnoor Specialist Hospital, Makkah, Saudi Arabia, from January 2015 to March 2019. Seventeen interventions were performed. The mean age was 39±3.6 years (range, 27–49 years), and 13 (76.5%) patients were males. The site of arterial injuries included superficial femoral artery in seven (41.2%) patients, deep femoral artery in one (5.9%) patient, one of the branches of internal iliac artery in five (29.4%) patients, anterior division of right hepatic artery in one (5.9%) patient, and subclavian artery in three (17.6%) patients. The injuries were extravasation in seven (41.2%) patients, pseudoaneurysm in five (29.4%) patients, and arteriovenous fistula in five (29.4%) patients. Results Initial success was achieved in 15 (88.2%) patients. We failed in two (11.8%) patients who were converted to open surgery. Nine covered stents were deployed, gelfoam embolization in one patient, microparticles embolization in two patients (successful in one patient and failed in the other in whom vascular plug was used), and coil embolization in three patients. Early complications occurred in four patients (extravasation in one patient, puncture site hematoma in two patients, and partially occlusive thrombus/spasm of deep femoral artery in one patient). Late complications occurred in two patients in the form of stent graft occlusion who underwent short bypass. The median follow-up time was 15 months (range, 5–24 months). Mean intervention-free period was 6.5 months. Conclusion Endovascular management of arterial injuries in hemodynamically stable patients can be a good alternative to open surgery in anatomic regions that are difficult to access and unfit patients for major surgery with possibility of massive blood loss.