Quickshot: Trends in Diagnosis & Management of Iliac Vein Trauma

Trauma to the iliac veins is rare, occurring in less than 6.5% of all vascular injuries, but has high mortality rate ranging from 55.6% to 100%. There is a paucity of research regarding this topic. This study aims to describe trends in the diagnosis, management, and outcomes of iliac vein injuries.

Methods:

The AAST Prospective Observational Vascular Injury Trial (PROOVIT) registry which includes data from 31 trauma centers.  The registry was queried for all patients with traumatic iliac vein injuries from 2013 to 2022. Trends of management with open, endovascular (endo), mixed open/endo and observation were evaluated.  

Results:

60 patients were identified with iliac vein injury. 28% [17/60] were due to blunt, 67% [40/60] due to penetrating and 5% [3/60] with mixed trauma. Definitive diagnosis was made with operative exploration in 73% [44/60], CT imaging in 23% [14/60], and angiogram in 3% [2/60]. 18% [11/60] underwent observation, 8% [5/60] endo, 72% [43/60] open, and 2% [1/60] mixed management. Damage control with ligation was performed in 26% [11/43] open cases. Primary repair was performed in the majority of open cases 88% [36/41]. Systemic heparin was given in 12% [5/43] open and 40% [2/5] endo cases. Patients received antiplatelets (AP) in 18% [11/60] and anticoagulation (AC) in 64% [29/45]. 18% [2/11] of the observation group required intervention. Re-intervention was required for 20% [1/5] of the endo group, 5% [2/41] of the open group, and 100% of the mixed group. In-hospital death occurred for 20% [1/5] of the endo group and 14% [6/42] of the open group. 29% [17/59] were discharged on AC and 24% [14/59] on AP. 43 patients returned for follow-up ranging from 1 to 17 days with no patients requiring re-intervention.

Conclusions:

Iliac vein trauma is rare and there is sparse literature describing management, treatment and outcomes. This study shows that open repair is commonly utilized likely due to penetrating mechanism. Post-op AC or AP therapy varies based upon provider, but follow-up outcomes showed no difference between the groups. Further prospective studies are needed to explore this topic further regarding optimal management techniques.