M. A. Dale1, A. Person1, G. Mendoza1, S. Brown1, D. Keleny1, D. Rigg1, J. Dabestani1, D. Agrawal1, J. Asensio1 1Creighton University Medical Center,Department Of Surgery,Omaha, NE, USA
Introduction: Axillary vessel injuries remain uncommon even in busy urban trauma centers. Most trauma surgeon possess limited experience with these injuries. The proximity of the surrounding anatomic structures account for a large number of associated injuries and mobidity associated with such injuries.
Methods: The National Trauma Data bank was queried for pre-hospital admission data for axillary vessel injuries. Data extracted included demographics, physiologic conditioins, surgical interventions and Functional Independent Measure Score (FIM). Univariate and stepwise logistic regression analysis were used.
Results: 590 cases were identified from 1,466,887 patients in NTDB from 2001-2005. Incidence = 0.004%. Mean age 33 ± 16, mean RTS 6.8 ± 2.3, mean Glasgow Coma Score 13 ± 4.4, mean ISS 14.9 ± 10.3. Mechanism of inury: penetrating n=329 (55.6%), blunt n=259 (43.9%), and non-specified n=2 (0.34%). Mean initial SBP 119.7 ± 37.7, mean in survivors 122.8 ± 24.8, mean in non-survivors 79.7 ± 56.1. Base deficit mean -3.7 ± 10.7, in survivors -3.3 ± 8.5, non-survivors -7.3 ± 19.2. Total number of injuries n=681, of these axillary artery n=455 (67%), axillary vein n=144 (21%), axillary nerve n=68 (9.98%), unspecified n=14 (2%). Sugical procedures for axillary injuries were documented in 238 patients, these included n=54 (15.4%) suture of the artery, n=38 (8.91%) vascular shunt or bypass. Complications n=2637 associated with axillary vessel injuries: pneumonia n=22 (16.05%), wound infection n=16 (11.67%), compartment syndrome n=14 (10.21%), ARDS n=12 (8.76%). Fuctional Independent Measures: dependent n=11 (1.86%), partial help required n=13 (2.2%), independent with device n=28 (4.75%), independent n=210 (35%), not applicable (7.3%), and not documented n=285 (48.3%). Survivors n=548 (92.88%), non-survivors n=42 (7.12%).
Conclusion: Axillary vessel injuries remain an uncommon occurence in the United States as denoted by their low incidence as reported in the NTDB and literature. Initial admitting systolic blood pressure has a higher correlation with morbidity based on mechanism of inury. However, when using stepwise logitistic models, ISS, TRISS, and LOS had the highest correlation with survival. Axillary vessel repairs require complex surgical interventions. Most injuries carry an associated high morbidity, good functional outcomes, and relative low mortality.
