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Home > Vascular Annual Meeting > PVSS15. Endovascular Treatment of Peripheral Arterial Trauma

PVSS15. Endovascular Treatment of Peripheral Arterial Trauma

Sheila M. Coogan, MD; Jaime Valdes, MD; Ali Azizzadeh, MD; Kourosh Keyhani, MD; Adel D. Irani, MD; Charles C. Miller III, PhD; Anthony L. Estrera, MD; Hazim J. Safi, MD
Univ. of Texas Med. School at Houston, Houston, TX; Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, TX

OBJECTIVES: The use of stent graft technology has led to a novel approach in the management of peripheral arterial trauma. Covered stents may be inserted and deployed percutaneously through a remote site and are ideal for treating arterial ruptures, pseudoaneurysms and arteriovenous fistulas. We reviewed our experience with stent grafts in treating patients with peripheral arterial trauma.

METHODS: A retrospective review of a prospectively collected institutional trauma registry was performed. Between July 1, 2004 and Feb 28, 2009, 223 patients with peripheral artery injuries presented to our institution. Of these, 108 required open or endovascular repair. Charts for all patients receiving a stent graft for treatment of peripheral arterial trauma were reviewed. Age, gender, Injury Severity Score (ISS ), mechanism of injury, injured vessel, pre-operative angiographic findings, fluoroscopy time, technical success, limb salvage, length of stay, mortality, and follow-up were recorded.

RESULTS: 17 patients underwent endovascular repair using Viabahn stent grafts (WL Gore, Flagstaff, AZ). Median age was 39 years old (13 to 88). Five patients were female. The median ISS was 17 (range 9-57). The mechanism of injury was: gunshot wound (8), iatrogenic (6), blunt trauma (2), stab wound (1). Injured arteries included: 3 axillary, 5 popliteal, 3 subclavian, 3 carotid, 2 iliac, and 1 superficial femoral artery. The most common pre-operative angiographic findings were pseudoaneurysm, contrast extravasation, occlusion and arterio-venous fistula. Technical success was 100%. The mean fluoroscopy time was 11.9 minutes. The 30 day patency rate was 88% (15/17). Two patients required subsequent open bypass prior to discharge due to stent thrombosis. One patient subsequently required amputation. Three patients died during the follow-up period from causes unrelated to their arterial repair. Mean length of stay was 21.5 days (1 to 93). The median follow-up time was 13 months (range 1-55 months).

CONCLUSIONS: Endovascular repair using stent grafts is feasible for a variety of peripheral arterial injuries with acceptable short term results. Patient recovery is dependent on the severity of associated injuries. Long term surveillance is needed to determine durability.

AUTHOR DISCLOSURES: S.M. Coogan, None; J. Valdes, None; A. Azizzadeh, None; K. Keyhani, None; A.D. Irani, None; C.C. Miller, None; A.L. Estrera, None; H.J. Safi, None.