Endovascular Treatment for Vascular Trauma

Treatment paradigms for bleeding and major vascular injury have evolved with the rise of endovascular surgery. Just over 2% of trauma patients suffer a vascular injury. The decision for endovascular or open intervention should be guided by the patient’s clinical status, anatomy of the injury, and the resources available. Early endovascular procedures for solid organ injury are independently associated with a 35% reduction in mortality risk after controlling for major confounders, including mechanism of injury and presence of hypotension on arrival. In all-comers, the arterial injuries are transection (35%), occlusion (17%), partial transection/flow limiting defect (25%), pseudoaneurysm (9.0%), and other injuries including intimal defects (23%). Over half of the patients can be managed with non-operative management with a low 4% failure rate and conversion to intervention. Definitive endovascular and open repair were used in <10% and <25% of all patients, respectively, presenting to level 1 trauma centers.