Life and Limb: Current Concepts in Endovascular Treatment of Extremity Trauma

Abstract

Traumatic injury is the leading cause of death worldwide in younger patient populations and extremity trauma with associated vascular injury accounts for many trauma-related deaths. Iatrogenic injury is also a common cause of extremity vascular trauma and the incidence of iatrogenic injury will likely increase as endovascular techniques continue to become more ubiquitous. For many vascular injuries involving the extremities, surgical repair is viewed as the standard of care. Historically, endovascular techniques did not play a role in the treatment of these vascular injuries, rather they were utilized only as part of the diagnostic assessment; however, there is an increasing trend toward endovascular management of extremity vascular trauma. No validated, widely implemented algorithm to select patients for endovascular intervention exists. Transcatheter techniques, however, play an important role in the management of these patients. For arterial injuries, embolization can be used to rapidly achieve hemostasis if the vessel can be sacrificed. More advanced endovascular techniques such as stent-graft placement may be best employed in the context of isolated, proximal extremity injuries, although there is increasing literature supporting the use of advanced techniques for more distal arterial injuries. The management of peripheral venous trauma remains controversial; however, there is growing data describing successful endovascular management of some peripheral venous injuries. The purpose of this article is to review extremity vascular trauma, concepts of injury triage, endovascular techniques, and intraprocedural considerations.

Keywords

interventional radiology - trauma - extremity trauma - vascular injury - endovascular - vascular surgery

Contribution

All authors have read and contributed to this manuscript.

Disclosure

J.F.B.C. is a consultant and speaker for Guerbet and C. R. Bard.

E.J.M. is a scientific advisor and speaker for Biogen.

G.E.J. is an advisor for Boston Scientific Corporation and Genentech.

Remaining authors have no relevant disclosures.

Publikationsverlauf

Artikel online veröffentlicht:
15. April 2021

• References

• 1 Institute of Medicine (US) Committee on Injury Prevention and Control. Reducing the Burden of Injury: Advancing Prevention and Treatment. Washington, DC: National Academies Press; 1999: 336
• 2 World Health Organization. World health statistics 2018: monitoring health for the SDGs [Internet]. 2018 [cited August 31, 2020]. Accessed January 15, 2021 at: http://apps.who.int/iris/bitstream/handle/10665/272596/9789241565585-eng.pdf?ua=1
• 3 Feliciano DV, Moore FA, Moore EE. et al; Western Trauma Association/Critical Decisions in Trauma. Evaluation and management of peripheral vascular injury. Part 1. Western Trauma Association/critical decisions in trauma. J Trauma 2011; 70 (06) 1551-1556
• 4 Kuwahara JT, Kord A, Ray Jr CE. Penetrating extremity trauma endovascular versus open repair?. Semin Intervent Radiol 2020; 37 (01) 55-61
• 5 Giswold ME, Landry GJ, Taylor LM, Moneta GL. Iatrogenic arterial injury is an increasingly important cause of arterial trauma. Am J Surg 2004; 187 (05) 590-592 , discussion 592–593
• 6 Reuben BC, Whitten MG, Sarfati M, Kraiss LW. Increasing use of endovascular therapy in acute arterial injuries: analysis of the National Trauma Data Bank. J Vasc Surg 2007; 46 (06) 1222-1226
• 7 Worni M, Scarborough JE, Gandhi M, Pietrobon R, Shortell CK. Use of endovascular therapy for peripheral arterial lesions: an analysis of the National Trauma Data Bank from 2007 to 2009. Ann Vasc Surg 2013; 27 (03) 299-305
• 8 Lohan DG, Tomasian A, Krishnam M, Jonnala P, Blackwell KE, Finn JP. MR angiography of lower extremities at 3 T: presurgical planning of fibular free flap transfer for facial reconstruction. AJR Am J Roentgenol 2008; 190 (03) 770-776
• 9 Rosson GD, Singh NK. Devascularizing complications of free fibula harvest: peronea arteria magna. J Reconstr Microsurg 2005; 21 (08) 533-538
• 10 Shin DS, Magill DB, Johnson GE, Ingraham CR, Kogut MJ, Monroe EJ. Upper extremity catheter angiography: indications, techniques, anatomy, and classic cases. J Clin Intervent Radiol ISVIR 2018; 02 (02) 87-94
• 11 Rieger M, Mallouhi A, Tauscher T, Lutz M, Jaschke WR. Traumatic arterial injuries of the extremities: initial evaluation with MDCT angiography. AJR Am J Roentgenol 2006; 186 (03) 656-664
• 12 McDonald Jr EJ, Goodman PC, Winestock DP. The clinical indications for arteriography in trauma to the extremity. A review of 114 cases. Radiology 1975; 116 (01) 45-47
• 13 Shah N, Anderson SW, Vu M, Pieroni S, Rhea JT, Soto JA. Extremity CT angiography: application to trauma using 64-MDCT. Emerg Radiol 2009; 16 (06) 425-432
• 14 Bozlar U, Ogur T, Norton PT, Khaja MS, All J, Hagspiel KD. CT angiography of the upper extremity arterial system: Part 1 - Anatomy, technique, and use in trauma patients. AJR Am J Roentgenol 2013; 201 (04) 745-752
• 15 Ivatury RR, Anand R, Ordonez C. Penetrating extremity trauma. World J Surg 2015; 39 (06) 1389-1396
• 16 Scott AR, Gilani R, Tapia NM, Mattox KL, Wall MJ, Suliburk JW. Endovascular management of traumatic peripheral arterial injuries. J Surg Res 2015; 199 (02) 557-563
• 17 Padia SA, Ingraham CR, Moriarty JM. et al. Society of Interventional Radiology Position Statement on endovascular intervention for trauma. J Vasc Interv Radiol 2020; 31 (03) 363-369.e2
• 18 Carrick MM, Morrison CA, Pham HQ. et al. Modern management of traumatic subclavian artery injuries: a single institution's experience in the evolution of endovascular repair. Am J Surg 2010; 199 (01) 28-34
• 19 Fox N, Rajani RR, Bokhari F. et al; Eastern Association for the Surgery of Trauma. Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73 (05) (Suppl. 04) S315-S320
• 20 O Dell MC, Shah J, Martin JG, Kies D. Emergent endovascular treatment of penetrating trauma: solid organ and extremity. Tech Vasc Interv Radiol 2017; 20 (04) 243-247
• 21 Gilani R, Tsai PI, Wall Jr MJJ, Mattox KL. Overcoming challenges of endovascular treatment of complex subclavian and axillary artery injuries in hypotensive patients. J Trauma Acute Care Surg 2012; 73 (03) 771-773
• 22 Karkos CD, Karamanos DG, Papazoglou KO. et al. Ruptured pseudoaneurysm of the profunda femoris artery due to pellet injury: endovascular treatment by coil embolization. Cardiovasc Intervent Radiol 2009; 32 (04) 837-839
• 23 Allison SK, Ingraham C, Aarabi S, Kogut M. Iatrogenic common iliac artery rupture from resuscitative endovascular balloon occlusion of the aorta. J Vasc Interv Radiol 2017; 28 (04) 619-620
• 24 Johnson CA. Endovascular management of peripheral vascular trauma. Semin Intervent Radiol 2010; 27 (01) 38-43
• 25 Xenos ES, Freeman M, Stevens S, Cassada D, Pacanowski J, Goldman M. Covered stents for injuries of subclavian and axillary arteries. J Vasc Surg 2003; 38 (03) 451-454
• 26 Maynar M, Baro M, Qian Z. et al. Endovascular repair of brachial artery transection associated with trauma. J Trauma 2004; 56 (06) 1336-1341 , discussion 1341
• 27 Chong VE, Lee WS, Miraflor E, Victorino GP. Applying peripheral vascular injury guidelines to penetrating trauma. J Surg Res 2014; 190 (01) 300-304
• 28 Kumar V. Endovascular treatment of penetrating injury of axillary vein with Viabahn endoprosthesis. J Vasc Surg 2004; 40 (06) 1243-1244
• 29 Sam II AD, Frusha JD, McNeil JW, Olinde AJ. Repair of a blunt traumatic inferior vena cava laceration with commercially available endografts. J Vasc Surg 2006; 43 (04) 841-843
• 30 Tillman BW, Vaccaro PS, Starr JE, Das BM. Use of an endovascular occlusion balloon for control of unremitting venous hemorrhage. J Vasc Surg 2006; 43 (02) 399-400
• 31 Chick JFB, Khaja MS, Han S, Cooper KJ, Meadows JM, Williams DM. Single-session total endovascular iliocaval reconstruction with stent grafting for the treatment of inferior vena cava agenesis and concurrent iliac venous aneurysm rupture. J Vasc Surg Cases Innov Tech 2017; 3 (03) 132-135
• 32 Arterial Injury in the Upper Extremity- Clinical Key [Internet]. [cited August 12, 2020]. Accessed January 15, 2021 at: https://www-clinicalkey-com.offcampus.lib.washington.edu/#!/content/playContent/1-s2.0-S0749071217301191?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0749071217301191%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F29169600%2F
• 33 Burdick TR, Hoffer EK, Kooy T. et al. Which arteries are expendable? The practice and pitfalls of embolization throughout the body. Semin Intervent Radiol 2008; 25 (03) 191-203
• 34 Maleux G, Stockx L, Brys P. et al. Iatrogenic pseudoaneurysm in the upper arm: treatment by transcatheter embolization. Cardiovasc Intervent Radiol 2000; 23 (02) 140-142
• 35 Bauer JR, Ray CE. Transcatheter arterial embolization in the trauma patient: a review. Semin Intervent Radiol 2004; 21 (01) 11-22
• 36 Cantasdemir M, Kantarci F, Mihmanli I, Numan F. Embolization of profunda femoris artery branch pseudoaneurysms with ethylene vinyl alcohol copolymer (onyx). J Vasc Interv Radiol 2002; 13 (07) 725-728
• 37 Mavili E, Donmez H, Ozcan N, Akcali Y. Endovascular treatment of lower limb penetrating arterial traumas. Cardiovasc Intervent Radiol 2007; 30 (06) 1124-1129
• 38 Moramarco LP, Fiorina I, Quaretti P. Endovascular management of upper and lower extremity vascular trauma. Endovasc Today 2014; 9: 53-58
• 39 Lönn L, Delle M, Karlström L, Risberg B. Should blunt arterial trauma to the extremities be treated with endovascular techniques?. J Trauma 2005; 59 (05) 1224-1227
• 40 White R, Krajcer Z, Johnson M, Williams D, Bacharach M, O'Malley E. Results of a multicenter trial for the treatment of traumatic vascular injury with a covered stent. J Trauma 2006; 60 (06) 1189-1195 , discussion 1195–1196
• 41 DuBose JJ, Rajani R, Gilani R. et al; Endovascular Skills for Trauma and Resuscitative Surgery Working Group. Endovascular management of axillo-subclavian arterial injury: a review of published experience. Injury 2012; 43 (11) 1785-1792
• 42 Williams TK, Clouse WD. Current concepts in repair of extremity venous injury. J Vasc Surg Venous Lymphat Disord 2016; 4 (02) 238-247
• 43 Madden NJ, Calligaro KD, Zheng H, Troutman DA, Dougherty MJ. Outcomes of brachial artery access for endovascular interventions. Ann Vasc Surg 2019; 56: 81-86
• 44 Aksoy M, Taviloglu K, Yanar H. et al. Percutaneous transcatheter embolization in arterial injuries of the lower limbs. Acta Radiol 2005; 46 (05) 471-475
• 45 Butterworth JW, Butterworth WA, Wu R. Three-year delayed presentation of femoral pseudoaneurysm after penetrating limb trauma. Ann Vasc Surg 2015; 29 (02) 362.e11-362.e15
• 46 Stolt M, Braun-Dullaeus R, Herold J. Do not underestimate the femoral pseudoaneurysm. Vasa 2018; 47 (03) 177-185
• 47 Jolly SS, Yusuf S, Cairns J. et al; RIVAL Trial Group. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet 2011; 377 (9775): 1409-1420
• 48 Kumar AJ, Jones LE, Kollmeyer KR. et al. Radial artery access for peripheral endovascular procedures. J Vasc Surg 2017; 66 (03) 820-825
• 49 Kim D, Arbra CA, Ivey JS, Burchett P, Gonzalez G, Herrera FA. Iatrogenic radial artery injuries: variable injury patterns, treatment times, and outcomes. Hand (N Y) 2021; 16 (01) 93-98
• 50 Jones LE, Yang KH, Feldtman RW. et al. Safety and efficacy of arterial closure devices in an office-based Angiosuite. Ann Vasc Surg 2018; 51: 10-17
• 51 Vidi VD, Matheny ME, Govindarajulu US. et al. Vascular closure device failure in contemporary practice. JACC Cardiovasc Interv 2012; 5 (08) 837-844
• 52 Cox T, Blair L, Huntington C, Lincourt A, Sing R, Heniford BT. Systematic review of randomized controlled trials comparing manual compression to vascular closure devices for diagnostic and therapeutic arterial procedures. Surg Technol Int 2015; 27: 32-44
• 53 Smith JC, Monroe EJ, Shivaram GM, Shaw DWW, Koo KSH. An update on the use of an arterial closure device following femoral arterial puncture in children. Pediatr Radiol 2019; 49 (09) 1217-1221
• 54 Jiao A, Goldman D, Hussain J. et al. Aspiration thrombectomy-assisted endovascular retrieval of an embolized angio-seal device causing claudication. Ann Vasc Surg 2019; 60: 476.e7-476.e11