Endovascular Repair of Penetrating Arterial Injuries in Puerto Rico
Antonio Arrieta, Gabriel Castro Gueits, Natalia Roa, Fernando Joglar
University of Puerto Rico, San Juan, PR
INTRODUCTION:Penetrating arterial injury represents (PAI) 1-2% of all trauma patients reported and 20% of trauma related deaths1. They can be divided into peripheral and central injuries. Peripheral injuries are injuries to any artery in the upper or lower extremities. Central penetrating injuries comprise a wide array ranging from aorta, carotid, visceral, renal and vertebral injuries. Historically these patients were managed by open repairs which are complex, require a lot of dissection and risks damaging surrounding structures2. As endovascular repairs started to emerge as an alternative option to open repairs, we wanted to describe the characteristics and outcomes of all PAI repaired by an endovascular approach at the Puerto Rico Trauma Hospital since its introduction in January 2011.METHODS:The study used a case series design. We used data from the PRTH Registry correlated with ACS Case Log - Surgeon Specific Registry of the operating surgeon. The domains measured were sociodemographic profile, injury characteristics, hospital course, and outcomes [i.e., hospital length of stay (LOS) and mortality]. The statistical analysis is expressed as median with range or frequencies and proportions, as appropriate. The protocol is IRB Approved: B0030420.RESULTS:Between January 1, 2011 and January 1, 2021, a total of 13,974 patients were admitted to the PRTH. Of these patients, 16 (0.11%) underwent endovascular repair of PAI. 15 (93.8%) patients were male and 1 (6.2%) patient were female. The median age was 29 (17-69) years. Of the cohort, 2 (12.5%) patients had private insurance, 13 (81.25%) patients had public health insurance, and 1 (6.25%) were uninsured. The most common mechanism of trauma was GSW (14; 87.5%), followed by knife (1; 6.25%) and iatrogenic (1; 6.25%). The median ISS of this cohort was 75 (50-75) points. The distribution of injuries was; left axillosubclavian injury (8;50.0%), followed by thoracic aortic injury (3;18.75%), right axillosubclavian injury (2;12.5%), right renal artery (1;6.25%),right vertebral artery injury (1;6.25%) and abdominal aorta (1;6.25%). Moreover, the median hospital LOS amounted to 20.1 (3-61) days, and 2 (12.5%) patients died while hospitalized. The median follow-up for this trauma population was 1 months (0-85.5) months.CONCLUSIONS:Penetrating arterial injuries are an infrequent but lethal condition affecting a healthy young population in Puerto Rico. Endovascular repair for penetrating arterial injuries have been performed with good results at the PRTH for the last 10 years. We will continue gathering our long-term follow-up data to aid with the refinement of postop surveillance guidelines for this population.
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