title: Outcomes after External Iliac and Femoral Vascular Injuries.
abstract: BACKGROUND
  Vascular injuries occurring at the junction of the trunk and lower extremity are uncommon yet challenging because of their location and potential for associated truncal injuries. The purpose of this study was to examine and compare outcomes among patients sustaining external iliac and femoral vascular injuries.
  
  
  METHODS
  We performed a 13-year retrospective analysis of our level 1 trauma center database to identify and compare patients with external iliac and femoral vessel injuries. Multiple logistic regression analysis was performed to identify independent predictors for mortality.
  
  
  RESULTS
  During the study period, 135 patients with a median (interquartile range [IQR]) age of 25 (20-35) years were identified with external iliac (n = 29) and femoral vascular injuries (n = 106). The majority were male (85.9%) with a penetrating mechanism (84.5%), and the median (IQR) Injury Severity Score (ISS) was 16 (11-26). The overall mortality rate was 14.1%. In comparison with patients with femoral vascular injuries, patients with external iliac injuries presented with higher ISS (25 vs. 16, P < 0.001), lower Glasgow Coma Scale (14 vs. 15, P = 0.001) and had a higher incidence of mortality (41.4% vs. 6.6%, P < 0.001) and disability (13.8% vs. 1%, P = 0.007). Shunts were used in only 7 patients (5.2%). Stepwise logistic regression consistently identified external iliac injury (odds ratio, 15.6; 95% confidence interval, 1.72-141, P = 0.014 in best-fitted model) as independently associated with mortality.
  
  
  CONCLUSIONS
  In comparison with femoral vascular injuries, external iliac vascular injuries are associated with higher blood loss, more intense resuscitation, higher disability and mortality in patients sustaining junctional groin injuries. Early recognition and application of damage control techniques and resuscitative practices may result in improved outcomes.
authors.affiliation: Harbor-UCLA Medical Center, Department of Surgery, Torrance, CA.
authors.forename: Jerry J
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Harbor-UCLA Medical Center, Department of Surgery, Torrance, CA.
authors.forename: Hamid
authors.initials: H
authors.lastname: Alipour
authors.affiliation: Harbor-UCLA Medical Center, Department of Surgery, Torrance, CA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Yule
authors.affiliation: Harbor-UCLA Medical Center, Department of Surgery, Torrance, CA.
authors.forename: David S
authors.initials: DS
authors.lastname: Plurad
authors.affiliation: Harbor-UCLA Medical Center, Department of Surgery, Torrance, CA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Koopmann
authors.affiliation: Harbor-UCLA Medical Center, Department of Surgery, Torrance, CA.
authors.forename: Brant
authors.initials: B
authors.lastname: Putnam
authors.affiliation: Harbor-UCLA Medical Center, Department of Surgery, Torrance, CA.
authors.forename: Christian
authors.initials: C
authors.lastname: de Virgilio
authors.affiliation: Harbor-UCLA Medical Center, Department of Surgery, Torrance, CA. Electronic address: dekim@dhs.lacounty.gov.
authors.forename: Dennis Y
authors.initials: DY
authors.lastname: Kim
mesh_terms: D000328:Adult; D002140:California; D016208:Databases, Factual; D042241:Early Diagnosis; D057510:Endovascular Procedures; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D055815:Young Adult