title: Endovascular management of traumatic peripheral arterial injuries.
abstract: BACKGROUND
  Traumatic injuries to peripheral arterial vessels are increasingly managed with endovascular techniques. Early small series have suggested that endovascular therapy is feasible and decreases operative blood loss, but these data are limited. The purpose of this study was to evaluate the feasibility and outcomes of endovascular management of nonaortic arterial trauma.
  
  
  METHODS
  We reviewed records of traumatic nonaortic arterial injuries presenting at an urban level 1 trauma center from December 2009-July 2013. Patients undergoing treatment in interventional radiology and patients whose injuries occurred >72 h before presentation were excluded. Demographics, indicators of injury severity, operative blood loss, transfusion requirements, and clinical outcome were compared between patients undergoing endovascular and open management using appropriate inferential statistics.
  
  
  RESULTS
  During the study period, 17 patients underwent endovascular interventions and 20 had open surgery. There were 19 upper extremity and/or thoracic outlet arterial injuries, 15 lower extremity injuries and 11 pelvic injuries. Endovascular cases were completed using a vascular imaging C-arm in a standard operating room. Estimated blood loss during the primary procedure was significantly lower with endovascular management (150 versus 825 cc, P < 0.001). No differences were observed between cohorts in age, injury severity score, intensive care unit length of stay, arterial pH, transfusion requirements, inpatient complication rate, or mortality.
  
  
  CONCLUSIONS
  Our experience with endovascular management demonstrates its feasibility with commonly available tools. Operative blood loss may be significantly decreased using endovascular techniques. Further study is needed to refine patient selection criteria and to define long-term outcomes.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas. Electronic address: ascott@bcm.edu.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Scott
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Ramyar
authors.initials: R
authors.lastname: Gilani
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Tapia
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Mattox
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Wall
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: James W
authors.initials: JW
authors.lastname: Suliburk
mesh_terms: D000328:Adult; D001158:Arteries / Q000293:injuries* / Q000601:surgery; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D057510:Endovascular Procedures / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000601:surgery*; D055815:Young Adult
keywords: Arterial trauma; Endovascular therapy; Operative blood loss