Citation

Haqqani MH, Levin SR, Kalish JA, Brahmbhatt TS, Richman AP, Siracuse JJ, Farber A, Jones DW. Ann. Vasc. Surg. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1016/j.avsg.2021.06.002

PMID

unavailable

Abstract

INTRODUCTION: Penetrating injuries to the inferior vena cava (IVC) and/or iliac veins are a source of hemorrhage but may also predispose patients to venous thromboembolism (VTE). We sought to determine the relationship between iliocaval injury, VTE and mortality.

METHODS: The National Trauma Data Bank was queried for penetrating abdominal trauma from 2015-2017. Univariate analyses compared baseline characteristics and outcomes based on presence of iliocaval injury. Multivariable analyses determined the effect of iliocaval injury on VTE and mortality.

RESULTS: Of 9,974 patients with penetrating abdominal trauma, 329 had iliocaval injury (3.3%). Iliocaval injury patients were more likely to have a firearm mechanism (83% vs. 43%, P<0.001), concurrent head (P=0.036), spinal cord (P<0.001), and pelvic injuries (P<0.001), and higher total injury severity score (median 20 vs. 8.0, P<0.001). They were more likely to undergo 24-hour hemorrhage control surgery (69% vs. 17%, P<0.001), but less likely to receive VTE chemoprophylaxis during admission (64% vs. 68%, P=0.04). Of patients undergoing iliocaval surgery, 64% underwent repair, 26% ligation, and 10% unknown. Iliocaval injury patients had higher rates of VTE (12% vs. 2%), 24-hour mortality (23% vs. 2.0%) and in-hospital mortality (33% vs. 3.4%) (P<0.001 for all). VTE rates were similar following repair (14%) and ligation (17%). Iliocaval injury patients also had higher rates of cardiac complications (10.3% vs. 1.4%), acute kidney injury (8.2% vs. 1.3%), extremity compartment syndrome (4.0 vs. 0.2%), and unplanned return to OR (7.9% vs. 2.5%) (P<0.001 for all). In multivariable analyses, iliocaval injury was independently associated with risk of VTE (OR 2.12; 95% CI, 1.29-3.48; P = 0.003), and in-hospital mortality (OR = 9.61; 95% CI, 4.96-18.64; P < 0.001).

CONCLUSION: Iliocaval injuries occur in <5% of penetrating abdominal trauma but are associated with more severe injury patterns and high mortality rates. Regardless of repair type, survivors should be considered high risk for developing VTE.

Language: en