Open vs Endovascular Treatment of Traumatic Peripheral Arterial Injury: Propensity Matched Analysis.

Abstract

INTRODUCTION\nArterial injuries occur in the setting of blunt and penetrating trauma. Despite increasing use, there remains paucity of data comparing long term outcomes of endovascular vs open repair management of these injuries. The aim of our study is to compare outcomes and readmission rates of open vs endovascular repair of traumatic arterial injuries.\n\n\nMETHODS\nThe National Readmission Database (2011-2014) was queried for all adult (age ≥18y) patients presenting with peripheral arterial (axillary, brachial, femoral, and popliteal) injuries. Patients were stratified into 2 groups based on intervention: open vs endovascular approach. Propensity score matching (1:2 ratio) was performed. Outcome measures were complications, length of stay (LOS), 30-day-readmission, and cost of readmission.\n\n\nRESULTS\nA matched cohort of 786 patients was obtained (endovascular: 262, open: 524). Mean age was 45±17y and 79% were males. Median LOS was 4[2-6] days for the endovascular group vs. 3[2-5] days for the open group (p<0.01). The endovascular group had higher rates of seroma (4% vs. 2%; p=0.04) and arterial-thrombosis (13% vs. 7%; p<0.01) during index hospitalization. Patients who underwent endovascular repair had higher 30-day readmission (11% vs. 7%; p=0.03) and higher 30-day-open-reoperation (6% vs. 2%; p<0.01). On subanalysis of the patients who were readmitted, median cost of each readmission was higher in the endovascular group $47,000[$27,202-$56,763] compared to $21,000[$11,889-$43,503] in the open group.\n\n\nCONCLUSION\nEndovascular repair for peripheral arterial injuries was associated with higher rates of in-hospital complications, readmissions, and costs. As this new technology continues to undergo refinement, a thorough re-evaluation of its indications, risks, and benefits is warranted.