Transarterial interventions in civilian gunshot wound injury: experience from a level-1 trauma center

CVIR Endovascular

Original Article

Alex Lionberg¹  Qian Yu¹  Osman Ahmed¹  Jeffrey Leef¹  Jonathan Du¹  Rakesh Navuluri¹  Austin Clarey¹  Ethan Ungchusri¹  Brian Funaki¹  Kylie Zane¹  Karan Nijhawan¹  Priya Prakash² 

[1] Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, 60637, Chicago, IL, USA;Department of Surgery, University of Chicago Medical Center, 60637, Chicago, IL, USA;

关键词: Embolization;    Gun-shot wound;    Penetrating trauma;    Stent-graft;    Trauma;   

DOI  :  10.1186/s42155-023-00396-5

 received in 2023-06-02, accepted in 2023-10-04,  发布年份 2023

来源: Springer

【 摘 要 】

PurposeTo assess the effectiveness of trans-arterial vascular interventions in treatment of civilian gunshot wounds (GSW).Materials and methodsA retrospective review was performed at a level-1 trauma center to include 46 consecutive adults admitted due to GSW related hemorrhage and treated with endovascular interventions from July 2018 to July 2022. Patient demographics and procedural metrics were retrieved. Primary outcomes of interest include technical success and in-hospital mortality. Factors of mortality were assessed using a logistic regression model.ResultsTwenty-one patients were brought to the endovascular suite directly (endovascular group) from the trauma bay and 25 patients after treatment in the operating room (OR group). The OR group had higher hemodynamic instability (48.0% vs 19.0%, p = 0.040), lower hemoglobin (12.9 vs 10.1, p = 0.001) and platelet counts (235.2 vs 155.1, p = 0.003), and worse Acute Physiology and Chronic Health Evaluation (APACHE) score (4.1 vs 10.2, p < 0.0001) at the time of initial presentation. Technical success was achieved in all 40 cases in which targeted embolization was attempted (100%). Empiric embolization was performed in 6/46 (13.0%) patients based on computed tomographic angiogram (CTA) and operative findings. Stent-grafts were placed in 3 patients for subclavian artery injuries. Availability of pre-intervention CTA was associated with shorter fluoroscopy time (19.8 ± 12.1 vs 30.7 ± 18.6 min, p = 0.030). A total of 41 patients were discharged in stable condition (89.1%). Hollow organ injury was associated with mortality (p = 0.039).ConclusionEndovascular embolization and stenting were effective in managing hemorrhage due to GSW in a carefully selected population. Hollow organ injury was a statistically significant predictor of mortality. Pre-intervention CTA enabled targeted, shorter and equally effective procedures.

【 授权许可】

CC BY   
© Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and Springer International Publishing AG 2023

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