Factors affecting mortality rate with iliac vein injuries.

Over an 8-year period, 49 patients were treated for iliac vein injuries with 25 (51%) deaths. The iliac vein injuries and their mortality rates (MR) were: common iliac vein--40% (6/15), internal iliac vein--65% (9/14), external iliac vein--29% (4/14), and two or more iliac veins--100% (6/6). This MR (51%) was much higher than those (18% to 38%) found in other series. The factors associated with this significantly increased MR were: Trauma Score less than 11 (MR = 71% or 24/35), initial OR systolic BP less than 70 mm Hg (MR = 89% or 15/17), ISS greater than 28 (MR = 65% or 24/37), 10 or more units of blood in the first 24 hours (MR = 65% or 22/34), and no obtainable BP on admission to the ED (MR = 65% or 15/22). Although the overall calculated probability of survival (Ps) by TRISS methodology was 0.43, several deaths might have been prevented by more complete resuscitation including restoration of core temperature above 34 degrees or 35 degrees C, and by packing the pelvis and closing rather than allowing three or more separate additional hypotensive episodes to occur while attempting definitive control of bleeding vessels.