Damage control techniques for common and external iliac artery injuries: have temporary intravascular shunts replaced the need for ligation?

J Trauma. 2010 May;68(5):1117-20. doi: 10.1097/TA.0b013e3181d865c0.

Abstract

Background: Trauma to the common or external iliac arteries has a mortality rate of 24% to 60%. "Damage control" options for these severely injured vessels are either ligation or temporary intravascular shunts (TIVSs). Complications of ligation include a 50% amputation rate and up to 90% mortality. The primary goal of this study was to identify the consequences of using ligation versus TIVS for common or external iliac artery injuries in damage control scenarios.

Methods: All patients with injuries to an iliac artery (1995-2008) at a Level I trauma center were reviewed. Demographics and outcomes were analyzed using standard statistical methodology.

Results: Iliac artery injuries were present in 88 patients (71 external and 17 common; 72% penetrating; median Injury Severity Score, 25; mean hospital stay, 28 days). Most nonsurvivors (73%) died of refractory shock within the first 24 hours after presenting with hemodynamic instability (66%). Ligation was required in one (6%) common and 14 (20%) external iliac arteries. TIVS was used in two (12%) common and five (7%) external iliac arteries. Patients requiring ligation (1995-2005) or TIVS (2005-2008) for their common or external iliac arteries had similar demographics and injuries (p > 0.05). Compared with patients who underwent ligation, patients receiving TIVS required fewer amputations (47% vs. 0%) and fasciotomies (93% vs. 43%; p < 0.05). Mortality in the ligation group was 73%, versus 43% in the TIVS cohort.

Conclusions: TIVSs have replaced ligation as the primary damage control procedure for injuries to common and external iliac arteries. As a result, the high incidence of subsequent amputation has been virtually eliminated. With increased TIVS experience, an improvement in survival is likely.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Amputation / statistics & numerical data
  • Blood Vessel Prosthesis Implantation / instrumentation
  • Blood Vessel Prosthesis Implantation / methods*
  • Blood Vessel Prosthesis Implantation / trends
  • Female
  • Georgia / epidemiology
  • Health Services Needs and Demand
  • Humans
  • Iliac Artery* / injuries
  • Iliac Artery* / surgery
  • Injury Severity Score
  • Length of Stay / statistics & numerical data
  • Ligation / methods*
  • Ligation / statistics & numerical data
  • Male
  • Medical Audit
  • Patient Selection
  • Retrospective Studies
  • Statistics, Nonparametric
  • Survival Rate
  • Trauma Centers
  • Traumatology / methods
  • Traumatology / trends
  • Treatment Outcome
  • Wounds, Nonpenetrating / epidemiology
  • Wounds, Nonpenetrating / surgery*
  • Wounds, Penetrating / epidemiology
  • Wounds, Penetrating / surgery*