Analysis of 185 Iliac Vessel Injuries

Risk Factors and Predictors of Outcome

Juan A. Asensio, Patrizio Petrone, Gustavo Roldán, Eric Kuncir, Vincent L. Rowe, Linda Chan, William Shoemaker, Thomas V. Berne, Louis M. Messina, Robert C. MacKersie, Clayton H. Shatney, David Wisner, Lawrence J. Goldstein, James J. Peck

Research output: Contribution to journalArticle

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Abstract

Hypothesis: Iliac vascular injuries incur high mortality. Design: Retrospective 100-month study Oanuary 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.

Original languageEnglish
Pages (from-to)1187-1194
Number of pages8
JournalArchives of Surgery
Volume138
Issue number11
DOIs
StatePublished - Nov 2003
Externally publishedYes

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Iliac Vein
Wounds and Injuries
Iliac Artery
Mortality
Survival
Vascular System Injuries
Thoracotomy
Hospital Emergency Service
Cardiac Arrhythmias
Logistic Models
Exsanguination
Blood Pressure
Abdominal Injuries
Injury Severity Score
Intraoperative Complications
Inferior Vena Cava
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Asensio, J. A., Petrone, P., Roldán, G., Kuncir, E., Rowe, V. L., Chan, L., ... Peck, J. J. (2003). Analysis of 185 Iliac Vessel Injuries: Risk Factors and Predictors of Outcome. Archives of Surgery, 138(11), 1187-1194. https://doi.org/10.1001/archsurg.138.11.1187

Analysis of 185 Iliac Vessel Injuries : Risk Factors and Predictors of Outcome. / Asensio, Juan A.; Petrone, Patrizio; Roldán, Gustavo; Kuncir, Eric; Rowe, Vincent L.; Chan, Linda; Shoemaker, William; Berne, Thomas V.; Messina, Louis M.; MacKersie, Robert C.; Shatney, Clayton H.; Wisner, David; Goldstein, Lawrence J.; Peck, James J.

In: Archives of Surgery, Vol. 138, No. 11, 11.2003, p. 1187-1194.

Research output: Contribution to journalArticle

Asensio, JA, Petrone, P, Roldán, G, Kuncir, E, Rowe, VL, Chan, L, Shoemaker, W, Berne, TV, Messina, LM, MacKersie, RC, Shatney, CH, Wisner, D, Goldstein, LJ & Peck, JJ 2003, 'Analysis of 185 Iliac Vessel Injuries: Risk Factors and Predictors of Outcome', Archives of Surgery, vol. 138, no. 11, pp. 1187-1194. https://doi.org/10.1001/archsurg.138.11.1187
Asensio, Juan A. ; Petrone, Patrizio ; Roldán, Gustavo ; Kuncir, Eric ; Rowe, Vincent L. ; Chan, Linda ; Shoemaker, William ; Berne, Thomas V. ; Messina, Louis M. ; MacKersie, Robert C. ; Shatney, Clayton H. ; Wisner, David ; Goldstein, Lawrence J. ; Peck, James J. / Analysis of 185 Iliac Vessel Injuries : Risk Factors and Predictors of Outcome. In: Archives of Surgery. 2003 ; Vol. 138, No. 11. pp. 1187-1194.
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abstract = "Hypothesis: Iliac vascular injuries incur high mortality. Design: Retrospective 100-month study Oanuary 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.",
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AU - Asensio, Juan A.

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AU - Roldán, Gustavo

AU - Kuncir, Eric

AU - Rowe, Vincent L.

AU - Chan, Linda

AU - Shoemaker, William

AU - Berne, Thomas V.

AU - Messina, Louis M.

AU - MacKersie, Robert C.

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N2 - Hypothesis: Iliac vascular injuries incur high mortality. Design: Retrospective 100-month study Oanuary 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.

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