PC172. Comparative Trends in the Management of Peripheral Vascular Injuries at an Urban Level 1 Trauma Center: Trauma Versus Vascular Surgery

There is a lack of data describing the role for vascular surgery (VS) in the management of peripheral vascular trauma (PVT). We sought to evaluate practice patters with PVT at an urban level 1 trauma center. We performed a retrospective review of all patients presenting to an urban level 1 trauma center from 2009 and 2014. A total of 275 patients with 364 major PVT at or distal to the subclavian or external iliac vessels were analyzed. Demographics, diagnostic modalities, involved specialties, and repair techniques were documented. Univariate analysis was used to compare non-VS vs VS management. Without VS involvement, patients were more likely to undergo diagnostic exploration, have ligation for definitive repair, have an external tourniquet applied, and have radial or ulnar arterial injury. With VS involvement, patients were more likely to have injuries to the subclavian, axillary, and popliteal arteries or lower extremity veins, undergo imaging procedures for diagnosis, require advanced repair techniques, including proximal and distal vessel control, patch angioplasty, arterial bypass, balloon embolectomy, and percutaneous or hybrid procedures involving stent grafting and balloon occlusion. VS was more often involved when patients required temporary shunts, fasciotomy, and amputation. Between both groups, there was no difference in rates of primary vessel repair. The Table summarizes our findings. Non-VSs remain as first responders in the management of PVT. VS involvement in PVT is more often associated with more complicated injuries. Further training for non-VSs with more advanced techniques may be advisable.TableSummary of demographics and methods for perioperative and intraoperative management for patients presenting to a tertiary care, level 1 trauma center with peripheral vascular injuryOverall (n = 275)Vascular surgery involvement (n = 66)No vascular surgery involvement (n = 209)P valueAge, median (IQR) years29 (22-40)26 (21-38)29 (23-40).2Male sex234 (85)59 (89)175 (84).3Penetrating trauma232 (84)51 (77)181 (87).1Fasciotomy at surgery53 (19)21 (32)32 (15)