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The Emerging Role of Endovascular Therapy in the Treatment of Proximal Braciocephalic Arterial Injuries
Ashlee Vinyard, MD, Robert Wood, BS, Jennifer Dinning, Larry Martin, MD, Marc E. Mitchell, MD.
University of Mississippi Medical Center, Jackson, MS, USA.

Objectives: The repair of arterial injuries involving the proximal brachiocephalic vessels can be challenging. Endovascular repair (ER) of these arteries is a minimally invasive alternative to open surgical repair (OR) which is being utilized more frequently. This study compares the treatment of these injuries in the open and endovascular eras.
Methods: The national trauma data bank was queried for patients with injuries to the innominate, carotid, subclavian and axillary arteries during 2 time periods: 2000 to 2004 (GRP1) and 2013 to 2014 (GRP2). The two groups were compared for patient demographics, type of repair and outcomes.
Results:

GRP1 (1077 patients)GRP2 (1557 patients)Significance
Age33.6 years37.9 yearsp<.05
Injury severity score20.822.4NS
Blunt injury40%56%p<.05
No operation603 (56%)673 (43%)p<.05
Operative repair474 (44%)884 (57%)p<.05
OR470 (99%)648 (73%)
ER4 (1%)154 (17%)
OR and ER082 (9%)

The mortality rate for patients not undergoing arterial repair decreased from 25.0% in GRP1 to 17.1% in GRP2 (p<.05), but was not different for those undergoing arterial repair (GRP1 12.6%, GRP2 10.7%). The amputation rate for patients undergoing repair of the arterial injury decreased from 6.2% in GRP1 to 3.3% in GRP2 (p<.05), but remained the same in patients treated nonoperatively (GRP1 1.2%, GRP2 1.6%). Hospital length of stay and number of ICU days was significantly higher in GRP2.
Conclusions: The treatment of arterial injuries to the proximal brachiocecphalic vessels has evolved over the last decade with 26% of patients undergoing ER alone or in combination with OR. The limb salvage rate has significantly improved over the same time period. OR and ER of proximal brachiocephalic arterial injuries are complimentary techniques, both playing an important role in the treatment of these injuries.


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