Journal of Vascular and Endovascular Therapy

Editorial

The application of endovascular technology for the emergency treatment of traumatic vascular injuries may be a new frontier. This study examines recent nationwide use of endovascular therapy in acute arterial traumatic injuries.

This retrospective study used the National Trauma Data Bank (NTDB). Cases with a diagnosis of arterial vascular injury were identified according to the International Classification of Diseases, Ninth Revision, Clinical Modification, and procedure codes for endovascular therapy were selected. A descriptive analysis and multiple regressions were performed to identify variables predictive of outcomes.

The most recently available version of the National Trauma Data Bank (NTDB, version 4.3), 6 which incorporates data on trauma admissions between the years 1994 to 2003, was evaluated for endovascular interventions. The NTDB is maintained by the Subcommittee on Trauma Registry Programs from the American College of Surgeons Committee on Trauma. It contains a nonpopulation- based sample of hospitalized trauma patients within the us, with a robust contribution by larger hospitals with younger, more severely injured patients. All hospitals that participate have been designated as level I to IV trauma centers. The NTDB is the most complete national database for injured patients currently available. All data are subject to continuous quality improvement and a system of logistic checks found out by the NTDB. For NTDB 4.3, 448 trauma centers participated, with a predominance of facilities designated as level I and II.

We identified 12,732 patients with vascular injuries from 1994 to 2003. An endovascular technique was used to treat 281 patients, yielding an overall utilization rate of endovascular procedures for diagnosed acute arterial trauma of 2.2%. The first arterial endovascular procedure registered in the NTDB was in 1997, and only four were performed. Between 1997 and 2003, 7286 patients underwent open repair of their arterial injury, and 281 endovascular procedures (3.7%) were performed. Between 2000 and 2003, the proportion of endovascular interventions vs open for arterial trauma increased from 2.4% to 8.1%. Stent use substantially increased from 12 in 2000 to 30 in 2003; endo graft use increased from one in 2000 to 37 in 2003.

There were no differences in age or sex between the 2 treatment groups. Roughly equal numbers of blunt and penetrating injuries were treated by either technique. More endovascular procedures were performed at public than private institutions (163 vs 118) and university hospitals compared with community hospitals (157 vs 124), perhaps reflecting that this sort of emerging treatment is more likely to be applied in institutions with a tutorial affiliation. There were no regional variations in use of endovascular procedures vs open procedures among trauma centers reporting to the NTDB among the Northeast, Midwest, South, or West.

In patients with a traumatic arterial injury, a standard open surgical approach for repair is no longer the only option. The use of endovascular therapy within the setting of acute trauma is increasing in dramatic fashion, as evidenced by the steep slope of procedure volume in recent years. There was no corresponding change within the number of open procedures between 2000 and 2003. Our objective was to document this dramatic increase in endovascular arterial procedures and plan to describe the patient population taking advantage of these less-invasive procedures. To the simplest of our knowledge, this is often the primary systematic evaluation of endovascular technology for arterial injury in trauma among the myriad case reports and case series that have been published.