Evidence shows endovascular repair may be of more use than operative

Sep 11 2012

By Piriya Mahendra, medwireNews Reporter

Endovascular repair (ER) may be more viable for some patients with peripheral arterial trauma (PAT) than operative repair (OR), experts say.

The results of the US National Trauma Data Bank (NTDB) analysis, which compared the two methods, show that ER may lead to fewer immediate complications than OR. However, further research is needed to identify potential subgroups of PAT patients in whom ER may be superior to OR in the long term, write Cynthia Shortell (Duke University Medical Center, Durham, North Carolina, USA) and team.

Of 8977 patients who underwent ER or OR for PAT of the upper and lower extremities in the USA between 2007 and 2009, most patients were men (77.1%) and just under half were Caucasian (42.6%). The mean age was 34.7 years.

As reported in the Annals of Vascular Surgery, ER was more commonly performed for lower- (n=370, 10.4%) than upper-extremity lesions (n=161, 3.0%). Moreover, risk-adjusted analysis revealed that ER patients had significantly higher injury severity scores and were more likely to suffer a blunt (vs penetrating) mechanism of injury than OR patients.

ER patients were also significantly more likely to have multiple comorbidities than OR patients.

ER patients were a significant 21% less likely to experience immediate risk-adjusted complications (defined as postoperative wound, renal, pulmonary, bleeding, cardiac, coagulation, or systemic complications; or compartment syndrome) than were OR patients. However, in-hospital mortality between the two groups did not significantly differ.

The mean length of hospital stay was a significant 0.78 days (adjusted difference) shorter among ER than OR patients However, length of intensive care unit stay did not differ significantly between the two groups.

The authors say that their findings contradict the belief held by many vascular surgeons that ER is inappropriate for PAT management. "In our analysis, only 5.9% of PAT patients within the NTDB underwent ER," they point out. However, "we demonstrate that ER is a viable option for the management of patients with PAT."

They conclude: "Although patient selection will likely remain a crucial factor in deciding when to perform ER, our results suggest that the use of ER may be associated with a lower risk of immediate complications compared with OR."

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