Original scientific paper in-hospital and post-discharge outcomes with autologous versus prosthetic repair of traumatic abdominal vascular injuries: a 10-year review of the PROOVIT registry

Negar Nekooei; Danielle Brabender; Stephen Park; Christine Bent; Anaar Siletz; Kazuhide Matsushima; Morgan Schellenberg; Kenji Inaba; Joseph Dubose; Matthew Martin; AAST PROOVIT study group

doi:10.1016/j.amjsurg.2025.116413

Original scientific paper in-hospital and post-discharge outcomes with autologous versus prosthetic repair of traumatic abdominal vascular injuries: a 10-year review of the PROOVIT registry

Am J Surg. 2025 May 15:248:116413. doi: 10.1016/j.amjsurg.2025.116413. Online ahead of print.

Authors

Collaborators

AAST PROOVIT study group:
Emily Lenart, Peter E Fischer, Kimberly Barbee, Jonny Morrison, David Feliciano, Thomas M Scalea, David Skarupa, Jennifer A Mull, Yohan Diaz Zuniga, Jeanette M Podbielski, Garrett Jost, Richard D Catalano, Liz Penaloza, Ahmed M Abou Zamzam Jr, Luo-Owen Xian, Jennie Kim, Kenji Inaba, Nathaniel Poulin, John Myers, Michael Johnson, Kristin Rocchi, Cathline Layba, Samantha Shugar, Ramyar Gilani, Tikesha Smith, Reginva Knight, Peter Hammer, Scott T Trexler, Nicholas Namias, Jonathan P Meizoso, Juan Asensio, Joseph M Galante, Misty Humphries, Ravi R Rajani, Jaime Benarroch Gampel, Christopher Ramos, George Dulabon, Riyad Karmy Jones, Andreas Larentzakis, George Velmahos, Suresh Agarwal, Jayraan Badiee, Michael Sise, Matthew Martin, Daniel Cucher, Annette Taylor, Charlotte Tanner, Fausto Y Vinces, Salvatore Docimo, Matthew M Carrick, Kathy Rodkey, Sameer Hirji, Reza Askari, Forrest O Moore, Richard Butler, James Haan, Kelly Lightwine

Affiliations

¹ Department of Trauma and Acute Care Surgery, Los Angeles General Medical Center, Los Angeles, CA, USA. Electronic address: nnekooei@dhs.lacounty.gov.
² Department of Trauma and Acute Care Surgery, Los Angeles General Medical Center, Los Angeles, CA, USA. Electronic address: Danielle.Brabender@med.usc.edu.
³ Department of Trauma and Acute Care Surgery, Los Angeles General Medical Center, Los Angeles, CA, USA. Electronic address: stephen.park@med.usc.edu.
⁴ Department of Trauma and Acute Care Surgery, Los Angeles General Medical Center, Los Angeles, CA, USA. Electronic address: cbent@usc.edu.
⁵ Department of Trauma and Acute Care Surgery, Los Angeles General Medical Center, Los Angeles, CA, USA. Electronic address: Anaar.Siletz@med.usc.edu.
⁶ Department of Trauma and Acute Care Surgery, Los Angeles General Medical Center, Los Angeles, CA, USA. Electronic address: kazuhide.matsushima@med.usc.edu.
⁷ Department of Trauma and Acute Care Surgery, Los Angeles General Medical Center, Los Angeles, CA, USA. Electronic address: morgan.schellenberg@med.usc.edu.
⁸ Department of Trauma and Acute Care Surgery, Los Angeles General Medical Center, Los Angeles, CA, USA. Electronic address: Kenji.Inaba@med.usc.edu.
⁹ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas, Austin, TX, USA. Electronic address: joseph.dubose@austin.utexas.edu.
¹⁰ Department of Trauma and Acute Care Surgery, Los Angeles General Medical Center, Los Angeles, CA, USA. Electronic address: Matthew.Martin@med.usc.edu.

PMID: 40409145
DOI: 10.1016/j.amjsurg.2025.116413

Abstract

Purpose: Abdominal vascular injury (AVI) often coincides with bowel injury and abdominal contamination. Prosthetic materials may be necessary for vascular reconstruction, but outcomes are poorly understood. We examined outcomes in patients undergoing autologous vs. prosthetic open repair of AVI using a national database.

Methods: This retrospective cohort study (2013-2023) utilized the PROOVIT registry. Patients with abdominal aorta, inferior vena cava, iliac artery/vein, renal vein, or portal vein injuries who underwent open repair and survived ≥72 h were included. Univariate and multivariate analyses assessed the association between repair type and in-hospital vascular complications, including re-intervention, amputation, and bowel resection, as well as re-intervention outcomes specifically. Post-discharge data was also reviewed.

Results: A total of 142 patients met inclusion criteria, with 124 (87.3%) undergoing autologous repair, primarily as primary repairs with only 5 autologous vein grafts, and 18 (12.7%) undergoing prosthetic repair, including synthetic grafts and bovine pericardial patches, predominantly for arterial injuries (iliac artery, abdominal aorta). In univariate analysis, no significant differences were observed in in-hospital vascular complications, re-intervention, and infection. In adjusted analysis, prosthetic repairs showed a higher risk of in-hospital vascular complications (aOR 5.253, p = 0.017), but comparable risk of re-interventions (aOR 3.046, p = 0.138). Follow-up data (N = 36) revealed 2 complications (5.6%): one infection (autologous) and one thrombosis (prosthetic). Notably, no prosthetic repair required revision due to infection, either in-hospital or during extended follow-up.

Conclusions: Prosthetic repairs may be associated with higher overall complication rates compared to autologous repairs. However, despite the increased complexity of prosthetic repairs and adjustment for injury severity, the autologous cohort did not demonstrate a clear advantage in terms of re-intervention rates. Future studies with more homogeneous cohorts are needed to further confirm or refute the impact of different graft materials on patient outcomes.

Keywords: Autologous repair; PROOVIT; Prosthetic repair; Synthetic graft; Vascular trauma.