title: Management and outcomes of blunt common and external iliac arterial injuries.
abstract: OBJECTIVE
  Blunt iliac arterial injuries (BIAI) require complex management but are rare and poorly studied. We investigated the presentation, management, and outcomes of patients with blunt common or external iliac arterial injuries.
  
  
  METHODS
  We identified and reviewed 112 patients with BIAI admitted between 2000 and 2011 at a Level I trauma center. Patients with common/external iliac artery injuries (CE group) were primarily analyzed, with patients with injuries of the internal iliac artery or its major branches (IB group) included for comparison of pelvic arterial trauma.
  
  
  RESULTS
  Twenty-four patients had CE and 88 had IB injuries. Mean ages (45 ± 19 years) and gender (86% male) were similar between groups. The mean injury severity score was 40 ± 14 (CE, 36 ± 15; IB, 40 ± 14; P = .19), indicating severe trauma. Twenty (83%) of the CE patients presented with signs of leg malperfusion. Admission factors associated with CE injury were crush mechanism of injury (37% vs 17%; P = .03) and pelvic soft tissue trauma (50% vs 15%; P < .01). The CE group had higher early mortality rates, both within 3 hours of admission (50% vs 19%; P = .04) and prior to iliac intervention (42% vs 3%; P < .01). Among those surviving to management, CE patients were more likely to undergo open repair or revascularization (68% vs 3%; P < .01) and had a higher rate of leg amputation (50% vs 6%; P < .01), with 8/12 (67%) culminating in hemipelvectomy. Risk factors for amputation included leg malperfusion, high-grade pelvic fractures, pelvic soft tissue trauma, and increasing leg injury severity. Overall mortality was 40%, and was similar between the injury groups. Among CE patients, need for amputation, pelvic fractures, and wounds were associated with inpatient mortality.
  
  
  CONCLUSIONS
  This is the largest series to date of blunt CE injuries and demonstrates distinct clinical features and outcomes for these patients. They have high risk for early death and proximal leg amputation. CE injury is specifically associated with serious open pelvic soft tissue injury, which, along with high-grade pelvic fractures, is a risk factor for amputation and death. On-demand emergent endovascular intervention may play an important role in improving management of these complex injuries.
authors.affiliation: Division of General Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md. Electronic address: dharris@smail.umaryland.edu.
authors.forename: Donald G
authors.initials: DG
authors.lastname: Harris
authors.affiliation: Division of General Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Drucker
authors.affiliation: Division of Trauma Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Brenner
authors.affiliation: Division of Trauma Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Mayur
authors.initials: M
authors.lastname: Narayan
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Rajabrata
authors.initials: R
authors.lastname: Sarkar
authors.affiliation: Division of Trauma Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Crawford
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D006801:Humans; D007083:Iliac Artery / Q000293:injuries* / Q000601:surgery*; D015601:Injury Severity Score; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*