A. D. Person1, S. Brown1, G. Mendoza1, D. Keleny1, D. Rigg1, M. Dale1, J. Dabestani1, D. K. Agrawal1, J. A. Asensio1 1Creighton University Medical Center,Department Of Trauma Surgery And Surgical Critical Care,Omaha, NE, USA
Background: Iliac vessel injjuries are uncommon, even in high volume trauma centers. THey incur high morbidity and mortality. The objectives of this study were to review the National Trauma Data Bank experience with iliac injuries, identify predictors of outcome, and then report the outcomes of these injuries.
Methods: The National Trauma Data Bank was queried for pre-hospital and admission data for all iliac vessel injuries. The main outcome measured was survival. Statistical analysis included univariate and stepwise logistic regression.
Results: 1,590 patients were identified from 1,466,887 patients from the National Trauma Data Bank. Incidence of iliac vessel injury was 0.1%. Mean age of patients with these injuries was 35.7 +/- 18.8. Mean Revised Trauma Score (RTS) was 5.98 +/- 2.8, while the mean Injury Severity Score (ISS) was 26.1 +/- 13.4. The mechanism of injury distribution between penetrating and blunt was 804 (51%) and 777 (49%) respectively. In terms of the vessels injured, the iliac artery was injured, there were 1,174 arterial injuries, 651 venous injuries, and 84 unspecified injuries. Span data on surgical repairs was available in 380 patients. Surgical management is as follows: arteriorrhaphy 129 (34%), venorrhaphy 170 (45%), primary repair of artery and/or vein with vein and/or prosthetic patch 52 (14%), and interposition grafts 29 (8%). In total, there were 1,040 survivors (65.4%) and 550 non-survivors (34.6%).
Multiple factors, able to be assessed on presentation demonstrated statistical significance between survivors and non-survivors. Mean Systolic Blood Pressure on presentation was 110.36 vs. 83.45 (p<0.001) between survivors and non-survivors respectively. Mean Revised Trauma Score was 6.80 vs. 4.41 (p<0.001). Mean Injury Severity Score was lower in survivors at 23.62 vs. 31.17 (p<0.001). Glasgow Coma Scale was 12.5 vs. 7.2 (p=0.002).
Conclusion: Iliac vessel injuries are uncommon in the landscape of American trauma as denoted by their low incidence reported in the National Trauma Data Bank. Mortality remains high. Predictors of outcome may be identified from the initial admitting data. When stratified to mechanism of injury, this idea remains valid and also appears to correlate well with mortality.