Rethinking protocolized completion angiography following extremity vascular trauma: A prospective observational multicenter trial
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Published:2023-04-11
Issue:1
Volume:95
Page:105-110
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ISSN:2163-0763
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Container-title:Journal of Trauma and Acute Care Surgery
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language:en
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Short-container-title:J Trauma Acute Care Surg
Author:
Niziolek Grace M.,Keating Jane,Bailey Joanelle,Klingensmith Nathan J.,Moren Alexis M.,Skarupa David J.,Loria Anthony,Vella Michael A.,Maher Zoe,Moore Sarah Ann,Smith Michael C.,Leung Amanda,Shuster Kevin M.,Seamon Mark J.
Abstract
BACKGROUND
Completion angiography (CA) is commonly used following repair of extremity vascular injury and is recommended by the Eastern Association for the Surgery of Trauma practice management guidelines for extremity trauma. However, it remains unclear which patients benefit from CA because only level 3 evidence exists.
METHODS
This prospective observational multicenter (18LI, 2LII) analysis included patients 15 years or older with extremity vascular injuries requiring operative management. Clinical variables and outcomes were analyzed with respect to with our primary study endpoint, which is need for secondary vascular intervention.
RESULTS
Of 438 patients, 296 patients required arterial repair, and 90 patients (30.4%) underwent CA following arterial repair. Institutional protocol (70.9%) was cited as the most common reason to perform CA compared with concern for inadequate repair (29.1%). No patients required a redo extremity vascular surgery if a CA was performed per institutional protocol; however, 26.7% required redo vascular surgery if the CA was performed because of a concern for inadequate repair. No differences were observed in hospital mortality, length of stay, extremity ischemia, or need for amputation between those who did and did not undergo CA.
CONCLUSION
Completion angiogram following major extremity injury should be considered in a case-by-case basis. Limiting completion angiograms to those patients with concern for an inadequate vascular repair may limit unnecessary surgery and morbidity.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Critical Care and Intensive Care Medicine,Surgery
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