Transarterial Interventions in Civilian Gunshot Wound Injury: Experience from a Level-1 Trauma Center

Abstract

Purpose: To assess the effectiveness of trans-arterial vascular interventions in treatment of civilian gunshot wounds (GSW). Materials and Methods: A retrospective review was performed at a level-1 trauma center to include 46 consecutive adults admitted due to GSW related hemorrhage and treated with endovascular interventions from 7/2018 to 7/2022. Patient demographics and procedural metrics were retrieved. Primary outcomes of interest include technical success and in-hospital mortality. Factors of mortality were assessed using a logistic regression model. Results: Twenty-one patients were brought to the endovascular suite directly (endovascular group) from the trauma bay and 25 patients after treatment in the operating room (OR group). The OR group had higher hemodynamic instability (48.0% vs 19.0%, p=0.040), lower hemoglobin (12.9 vs 10.1, p=0.001) and platelet counts (235.2 vs 155.1, p=0.003), and worse APACHE score (4.1 vs 10.2, p<0.0001) at the time of initial presentation. Technical success was achieved in all 40 cases in which targeted embolization was attempted (100%). Empiric embolization was performed in 6/46 (13.0%) patients based on computed tomographic angiogram (CTA) and operative findings. Stent-grafts were placed in 3 patients for subclavian artery injuries. Availability of pre-intervention CTA was associated with shorter fluoroscopy time (19.8±12.1 vs 30.7±18.6 minutes, p=0.030). A total of 41 patients were discharged in stable condition (89.1%). Hollow organ injury was associated with mortality (p=0.039). Conclusion: Endovascular embolization and stenting were effective in managing hemorrhage due to GSW in a carefully selected population. Hollow organ injury was a statistically significant predictor of mortality. Pre-intervention CTA enabled targeted, shorter and equally effective procedures.