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Analysis of 185 Iliac Vessel Injuries
Risk Factors and Predictors of Outcome
Juan A. Asensio, MD;
Patrizio Petrone, MD;
Gustavo Roldán, MD;
Eric Kuncir, MD;
Vincent L. Rowe, MD;
Linda Chan, PhD;
William Shoemaker, MD;
Thomas V. Berne, MD
Arch Surg. 2003;138:1187-1194.
Hypothesis Iliac vascular injuries incur high mortality.
Design Retrospective 100-month study (January 1, 1992, through April 30, 2000).
Patients One hundred forty-eight patients with 185 iliac vessel injuries.
Outcome Measures Survival and mortality, analyzed by univariate and logistic regression.
Results Admission mean ± SD systolic blood pressure was 81 ± 42 mm Hg, mean Revised Trauma Score was 6.0 ± 2.8, and mean Injury Severity Score was 20.0 ± 9.5. The mechanism of injury was penetrating in 140 patients (95%) and blunt in 8 (5%). The mean estimated blood loss was 6246 ± 6174 mL. Of the 185 injured vessels, 71 (99%) of 72 iliac arteries were repaired, 101 (89%) of 113 iliac veins were ligated, and 12 (11%) of 113 iliac veins were repaired. Overall survival was 51% (76/148). Mortality was 82% (49/72) in patients with exsanguination. Survival by vessel: iliac artery, 57% (20/35); iliac vein, 55% (42/76); and iliac artery and vein, 38% (14/37). Significant predictors of outcome were thoracotomy in the emergency department, associated aortic injury, inferior vena cava injuries, iliac artery and vein injury, intraoperative arrhythmia, and intraoperative coagulopathy. On logistic regression, independent risk factors for survival were absence of thoracotomy in the emergency department, surgical management, and arrhythmia. Mortality by grade on the Organ Injury Scale of the American Association for the Surgery of Trauma (AAST-OIS) was as follows: grade III, 35% (33/95); grade IV, 71% (24/34); and grade V, 79% (15/19).
Conclusions Mortality remains high. Associated vessel injuries and intraoperative complications predict mortality. AAST-OIS grade for abdominal vascular injuries correlates well with mortality.
From the Department of Surgery, Division of Trauma and Critical Care, Los Angeles County, and University of Southern California Medical Center, Los Angeles.
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