Endovascular Approach for Peripheral Arterial Injuries

Background: In appropriate situations, treatment of arterial injuries with stent grafts decreases operative time, estimated blood loss, and iatrogenic complications when compared with open treatment. The purpose of this study was to describe the recent experience and outcomes of this technique in a large tertiary hospital. Methods: The medical records of 16 patients with peripheral arterial injuries were analyzed in a retrospective single-institution review. Results: Injuries were caused by trauma in 6 patients (38%), iatrogeny during vascular access in 6 (38%), and complications of open surgical procedures in 4 (25%). The subclavian-axillary segment was involved in 5 cases (31%), femoropopliteal artery in 5 (31%), carotid artery in 3 (19%), and iliac arteries in another 3 (19%). Clinical presentation of the injury was pseudoaneurysm in 8 cases (50%), arteriovenous fistula (AVF) in 3 (19%), bleeding in 3 (19%), and pseudoaneurysm associated with AVF in 2 (13%). All patients were hemodynamically stable at evaluation, and were treated with balloon-expanding or self-expanding stent grafts. All patients were followed up with a duplex scan, with a mean follow-up time of 17.3 months. No deaths or amputations occurred. Four patients (25%) returned with occluded stent grafts. Among them, 3 presented with mild or no symptoms. One patient was treated with open vascular bypass to treat limiting-arm symptoms. Conclusions: Treating penetrating arterial injuries with stent grafts was shown to be safe and effective.