title: Trading scalpels for sheaths: Catheter-based treatment of vascular injury can be effectively performed by acute care surgeons trained in endovascular techniques.
abstract: BACKGROUND
  The skill set of the acute care surgeon can be expanded by formal training. We report the first series of traumatic vascular injury (TVI) treated by acute care surgeons trained in endovascular techniques (ACSTEV).
  
  
  METHODS
  We retrospectively reviewed patients admitted to our trauma center with TVI over 5 months who survived for more than 24 hours and had catheter diagnosis and/or therapy by ACSTEV. Demographics, admission data, and outcomes were reviewed. Follow-up ranged from 0 day to 150 days.
  
  
  RESULTS
  Most patients were male (63%) and sustained blunt mechanism (91%). Mean (SD) age was 48.2 (21.9) years, and mean (SD) Injury Severity Score was 32.1 (11.8). Mean (SD) admission systolic blood pressure, heart rate, Glasgow Coma Scale (GCS) score were 126.12 (30.4) mm Hg, 101.21 (28.2) beats per minute, and 10.8 (4.73), respectively. Forty-six patients underwent 48 endovascular procedures for TVI: 32 angiograms and 16 venograms were obtained. Two pelvic angiograms and one aortic arch angiogram were negative and required no treatment. One superficial femoral artery arteriogram showed minor luminal defects requiring anticoagulation only. Pseudoaneurysms were found in 17 vessels, vessel truncation in 4, active extravasation in 5, stenosis in 1, and dissection with thrombus in 1. Four patients had resuscitative endovascular balloon occlusion of the aorta performed before catheter intervention for pelvic hemorrhage. Procedures included aortic repair (4), pelvic embolization (13), splenic embolization (5), lumbar artery embolization (1), bronchial artery embolization (1), profunda artery embolization (1), common carotid artery stent (1), celiac artery stent (1), inferior vena cava filter placement (14) and retrieval (2), and pharmacomechanical thrombolysis (1). Treatment material included coils (12), Gelfoam (4), and nitinol plugs (3). No procedural or device-related complications occurred. Mortality was 14.7% unrelated to any endovascular procedure. One patient had repeat coil embolization of a pelvic pseudoaneurysm on postoperative Day 7.
  
  
  CONCLUSIONS
  ACSTEV can safely treat TVI with good success. We performed nearly 10 procedures per month underscoring the role of the ACSTEV for training and care of TVI in a high-volume trauma center.
  
  
  METHODS
  Therapeutic study, level V.
authors.affiliation: From the Division of Trauma/Critical Care (M.B., M.H., W.T., D.S., T.S.), RA Cowley Shock Trauma Center, and Division of Vascular Surgery (M.B.), University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Megan
authors.initials: M
authors.lastname: Brenner
authors.forename: Melanie
authors.initials: M
authors.lastname: Hoehn
authors.forename: William
authors.initials: W
authors.lastname: Teeter
authors.forename: Deborah
authors.initials: D
authors.lastname: Stein
authors.forename: Thomas
authors.initials: T
authors.lastname: Scalea
mesh_terms: D000792:Angiography; D057785:Catheters; D004502:Education, Medical, Continuing / Q000379:methods*; D004636:Emergency Service, Hospital; D057510:Endovascular Procedures / Q000193:education / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D010690:Phlebography; D012189:Retrospective Studies; D012307:Risk Factors; D066231:Surgeons / Q000193:education*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D057772:Vascular System Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*