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