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 PS146. Patterns and Management of Blunt Iliac Arterial Injuries

Donald G. Harris1, Charles B. Drucker2, Megan L. Brenner3, Mayur Narayan3, Rajabrata Sarkar1, Thomas M. Scalea3, Robert S. Crawford1
1Surgery, University of Maryland Medical Center, Baltimore, MD; 2University of Maryland School of Medicine, Baltimore, MD; 3University of Maryland R Adams Cowley Shock Trauma Center, Baltimore, MD.

OBJECTIVES: Blunt iliac arterial injuries (BIAI) involve complex management, but are rare and poorly studied.

METHODS: We identified 112 patients with BIAI admitted between 2000-2011 from our registry. Twenty-four had common/external iliac artery injuries (CE group), and 88 involved the hypogastric or internal iliac branch arteries (IB group). Demographics, management and outcomes were compared between groups.

RESULTS: CE and IB patients were similar in age (42±15 vs. 46±19 years, p=0.46) and gender (83% vs. 75% male, p=0.32). Mean injury severity score was 40±14 (CE: 36±15, IB: 40±14, p=0.19), indicating severe trauma. CE patients had a higher rate of crush mechanism of injury (38% vs. 17%, p=0.03) and open pelvic wounds (50% vs. 15%, p<0.01). Rates of major pelvic fractures (79% vs. 64%, p=0.21), visceral organ injuries (54% vs. 48%, p=0.61) and genitourinary tract injuries (46% vs. 29%, p=0.11) were similar between groups. Overall inpatient mortality was 40%, (CE: 50%, IB: 36%, p=0.24). However, CE patients had higher mortality within 3 hours of admission (50% vs. 19%, p=0.04) and prior to iliac intervention (42% vs. 3%, p<0.01). Five patients were observed without complication (CE: 17%, IB: 1%, p<0.01). CE patients had more open (54% vs. 3%, p<0.01) and fewer endovascular (8% vs. 95%, p<0.01) interventions compared to IB patients. CE procedures included 8 bypasses, 3 primary repairs, 2 ligations and 2 endovascular procedures. IB patients had 3 open hypogastric ligations, 14 hypogastric coilings and 74 branch embolizations. CE patients had a higher rate of leg amputations (46% vs. 5%, p<0.01), with 8/11 (73%) culminating in hemipelvectomy.

CONCLUSIONS: This is the largest series to date of major BIAI. Blunt CE injuries are specifically associated with serious open pelvic soft tissue injury and are a marker of high risk for early death and leg amputation. Most CE injuries were treated with open surgery; however, there may be a role for emergency endovascular management given their location and distribution.

AUTHOR DISCLOSURES: M. L. Brenner: Nothing to disclose; R. S. Crawford: Nothing to disclose; C. B. Drucker: Nothing to disclose; D. G. Harris: Nothing to disclose; M. Narayan: Nothing to disclose; R. Sarkar: Nothing to disclose; T. M. Scalea: Nothing to disclose.

Posted April 2013

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