Outcomes Comparison of Endovascular and Open Surgical Approaches for Subclavian Arterial Injury: A Nationwide Analysis

Authors

Maru Kim, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA; Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Matthew Firek, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA.
Bruno C. Coimbra, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA; George Washington University School of Medicine and Health Sciences, Washington, DC.
Timothy Allison-Aipa, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA.
Bishoy Zakhary, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA.
Junsik Kwon, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA; Department of Trauma Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
Raul Coimbra, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA; Loma Linda University School of Medicine, Loma Linda, CA. Electronic address: rcoimbra@aast.org.

Document Type

Journal Article

Publication Date

3-1-2025

Journal

Annals of vascular surgery

Volume

112

DOI

10.1016/j.avsg.2024.12.055

Abstract

BACKGROUND: The management of patients with subclavian artery injury is rapidly evolving from an open to an endovascular approach. We aim to present an analysis of management and a comparison of outcomes according to the type of approach used to treat these challenging injuries. METHODS: Adult patients with subclavian arterial injuries were abstracted from the National Inpatient Sample database from 2012-2014 and 2016-2021. Patients were divided according to the type of management, which was endovascular management (EM; stent placement) or open surgery (OS), and clinical outcomes were compared. A multivariable logistic regression model was used to determine risk factors associated with in-hospital mortality. RESULTS: A total of 1200 cases were analyzed. The EM and OS groups had similar baseline characteristics, including age, sex, All Patient Refined Diagnosis-Related Groups severity of illness and risk of mortality scores, and Charlson Comorbidity Scores. The presence of shock on admission was similar between groups (EM: 23.1% vs. OS: 34.2%; P = 0.115). Median injury severity score was higher in the EM group but with a lower mortality rate (5.5% vs. 14.8%, P = 0.045) than OS. Additionally, EM was associated with a lower fasciotomy rate (P = 0.018). Hemorrhagic shock on presentation (odds ratio: 3.72) was associated with a marked increase in the odds of in-hospital mortality, while EM was associated with a 67% decrease (odds ratio: 0.33). CONCLUSIONS: EM is associated with significantly better outcomes, including lower odds of in-hospital mortality and a decreased need for fasciotomy. Currently, EM is a feasible option in the management of subclavian arterial injuries.

APA Citation

Kim, Maru; Firek, Matthew; Coimbra, Bruno C.; Allison-Aipa, Timothy; Zakhary, Bishoy; Kwon, Junsik; and Coimbra, Raul, "Outcomes Comparison of Endovascular and Open Surgical Approaches for Subclavian Arterial Injury: A Nationwide Analysis" (2025). GW Authored Works. Paper 6929.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6929

Department

School of Medicine and Health Sciences Student Works