Outcome comparison between open and endovascular management of axillosubclavian arterial injuries.
BACKGROUND
Endovascular repair (ER) of axillosubclavian arterial injuries is a minimally invasive alternative to open repair (OR). The purpose of this study was to compare the outcomes of ER vs OR.


METHODS
A retrospective study was performed of patients who sustained axillosubclavian arterial injuries admitted to two high-volume academic trauma centers between 2003 and 2013. Patients undergoing ER and OR were matched according to 25 different demographic and clinical variables in a 1:3 ratio using propensity scores. The primary outcome was in-hospital mortality. Secondary outcomes were complications and length of stay.


RESULTS
Among 153 patients (79.7% male; mean age, 32.7 ± 15.9 years) who sustained axillosubclavian arterial injuries, 18 (11.8%) underwent ER and 135 (88.2%) had OR. Matched cases (ER, n = 18) and controls (OR, n = 54) had similar demographic and clinical data, such as age, gender, admission systolic blood pressure and Glasgow Coma Scale score, body Abbreviated Injury Scale scores, Injury Severity Score, and transfusion requirements. Patients undergoing ER had significantly lower in-hospital mortality compared with patients undergoing OR (5.6% vs 27.8%; P = .040; odds ratio, 0.7; 95% confidence interval, 0.6-0.9). Similarly, patients undergoing ER had substantially lower rates of surgical site infections and a trend toward lower rates of sepsis. Outpatient follow-up was available in 88.2% (n = 15) of the patients at a median time of 8 months (1-30 months). Two ER patients required open reintervention for stent-related complications (one for a type Ia endoleak and another for stent thrombosis).


CONCLUSIONS
In our experience with axillosubclavian arterial injuries, ER was associated with improved mortality and lower complication rates. Patient follow-up demonstrates an acceptable reintervention rate after ER. Further multicenter prospective evaluation is warranted to determine long-term outcomes.
Department of Surgery, University of Arizona, Tucson, Ariz.
Bernardino C
BC
Branco
Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston, Tex.
Mina L
ML
Boutrous
Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston, Tex.
Joseph J
JJ
DuBose
Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston, Tex.
Samuel S
SS
Leake
Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston, Tex.
Kristopher
K
Charlton-Ouw
Division of Trauma, Emergency Surgery, Critical Care, and Burns, University of Arizona, Tucson, Ariz.
Peter
P
Rhee
Division of Vascular and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
Joseph L
JL
Mills
Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston, Tex. Electronic address: ali.azizzadeh@uth.tmc.edu.
Ali
A
Azizzadeh
D000293:Adolescent; D000328:Adult; D001130:Arizona; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D006801:Humans; D015601:Injury Severity Score; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D057216:Propensity Score; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D013781:Texas; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D055815:Young Adult