luis pino | Universidad del Valle - Colombia (original) (raw)

Papers by luis pino

Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2012

RESUMEN Antecedentes El abordaje quirúrgico en el trauma penetrante de tórax con herida pulmonar ... more RESUMEN Antecedentes El abordaje quirúrgico en el trauma penetrante de tórax con herida pulmonar requiere del conocimiento de las técnicas quirúrgicas. Se presenta una experiencia de 4 años en el manejo de las heridas pulmonares y se representa que la cirugía en trauma pulmonar se asocia a una mayor mortalidad. Métodos Los datos corresponde a un centro de trauma de nivel IV, con revisión de forma prospectiva desde 2008 hasta 2011. Los resultados de las intervenciones quirúrgicas correlacionando las lesiones pulmonares traumáticas. Obtenemos los resultados demográficos, quirúrgicos y mortalidad institucional. Resultados El total de los pacientes con trauma son 638, con intervención quirúrgica en trauma de tórax es de 134 pacientes, y por lesiones pulmonares 77 pacientes. el genero masculino es del 93% y edad promedio de 28 años de edad. corresponde con el 73,13% de causa por HAF. Las Intervenciones quirúrgicas incluidas son neumonorrafia n (46%), tractotomía n (25%), resección en cuñ...

World journal of surgery, Sep 17, 2017

The aim of this study was to compare the epidemiology of traumatic injuries and mortality outcome... more The aim of this study was to compare the epidemiology of traumatic injuries and mortality outcomes between two tertiary-care trauma centers in Colombia using data from Pan-American Trauma Registry (PATR). January 1-December 31, 2012, data from the Hospital Universitario del Valle (HUV, public) and Fundacion Valle del Lili (FVL, private) in Cali, Colombia, were considered. Differences in demographic and clinical information were compared using descriptive statistics. Propensity score matching was used to match patients on age, gender, and ISS. Within matched cohorts, multivariable logistic regression models were used to assess for differences in in-hospital mortality, further adjusting for insurance type, employment, heart rate, presence of hypotension (SBP < 90), and GCS score. HUV (8539; 78% male) and FVL (10,456; 60% male) had a combined total of 18,995 trauma cases in 2012 with comparable mean ages of 29.7 years. There were significant differences in insurance status, injury s...

Colombia medica (Cali, Colombia), Jan 30, 2016

Trauma information systems are needed to improve decision making and to identify potential areas ... more Trauma information systems are needed to improve decision making and to identify potential areas of intervention. To describe the first year of experience with a trauma registry in two referral centers in southwest Colombia. The study was performed in two referral centers in Cali. Patients with traumatic injuries seen between January 1 and December 31, 2012, were included. The collected information included demographics, mechanism of trauma, injury severity score (ISS), and mortality. A descriptive analysis was carried out. A total of 17,431 patients were registered, of which 67.8% were male with an average age of 30 (±20) years. Workplace injuries were the cause of emergency consultations in 28.2% of cases, and falls were the most common mechanism of trauma (37.3%). Patients with an ISS ≥15 were mostly found in the 18-35-year age range (6.4%). Most patients who suffered a gunshot wound presented an ISS ≥15. A total of 2.5% of all patients died, whereas the mortality rate was 54% am...

Revista Colombiana De Cirugia, Dec 1, 2009

Palabras clave: heridas y traumatismos; índices de gravedad del trauma; puntaje de gravedad del t... more Palabras clave: heridas y traumatismos; índices de gravedad del trauma; puntaje de gravedad del traumatismo; mortalidad. * Segundo premio al mejor trabajo presentado por un residente de Cirugía en el XXXV Congreso Colombiano de Cirugía, realizado en Medellín, 18 a 21 de agosto de 2009

Journal of Trauma and Acute Care Surgery, 2016

Dynamic and efficient resuscitation strategies are now being implemented in severely injured haem... more Dynamic and efficient resuscitation strategies are now being implemented in severely injured haemodinamically unstable (HU) patients as blood products become readily and more immediately available in the trauma room. Our ability to maintain aggressive resuscitation schemes in HU patients allow us to complete diagnostic imaging studies before rushing patients to the operating room. As the criteria for performing CT (Computed Tomography) scans in HU patients continue to evolve, we decided to compare the outcomes of immediate CT versus direct admission to the operating room (OR) and/or angio suite in a retrospective study at a government designated regional level I trauma center in Cali, Colombia. Over a two-year period (2012-2013), blunt and penetrating trauma patients (≥15 years old) with an injury severity score (ISS) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;15 who met criteria of haemodynamic instability (Systolic Blood Pressure (SBP) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;100 mmHg and/or Heart Rate &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;100bpm and/or ≥4 units of Packed Red Blood Cells transfused in the trauma bay) were included. Isolated head trauma and patients who suffered a pre-hospital cardiac arrest were excluded. The main study outcome was mortality. We reviewed 171 patients. CT scans were performed in 80 HU patients (47%) immediately upon arrival (CT Group); the remaining 91 patients (53%) went directly to the OR (63 laparotomies, 20 thoracotomies), and/or 8 (9%) angio-suite (OA Group). Of the CT group, 43 (54%) were managed non-operatively, and 37 (46%) underwent surgery (15 laparotomies, 3 thoracotomies); and 2 (5%) angiography (CT OA Sub-Group). None of the mortalities in the CT group occurred in the CT suite or during their intra-hospital transfers. There was no difference in mortality between the CT and OA groups in HU patients. CT scan was attainable in 47% of HU patients and avoided surgery in 54% of the cases. Furthermore, CT scan was helpful in deciding definitive/specific surgical management in 46% scanned HU patients that necessitated surgery post CT. Level IV Therapy/Care Management study.

Journal of the American College of Surgeons, 2015

Background Injury is a major cause of death and disability in low- and middle-income countries (L... more Background Injury is a major cause of death and disability in low- and middle-income countries (LMICs) where there is a paucity of injury data. We aimed to create information and communication infrastructure to evaluate injury patterns, identify areas for improvement and measure effectiveness of interventions at every level of health care facilities in LMICs. Methods We created an electronic trauma database in 3 languages (English, Spanish and Portuguese) with the ability to link hospital systems at a local, regional and national level. Access is through either a secure online website or software installation where internet is limited. The database consists of 50 essential elements, expandable up to 250 elements, per record, using the ICD-10 system and Injury Severity Scores. It can generate fixed or modifiable reports and import/export data for statistical analysis. We implemented this system in 3 countries as a pilot program for clinicians, administrators and data entry personnel,...

Palabras clave: centros traumatológicos; índices de gravedad del trauma; puntaje de gravedad del ... more Palabras clave: centros traumatológicos; índices de gravedad del trauma; puntaje de gravedad del traumatismo; registros electrónicos de salud.

Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2014

RESUMEN Introducción Dado que las lesiones relacionadas con colisiones de vehículos motorizados s... more RESUMEN Introducción Dado que las lesiones relacionadas con colisiones de vehículos motorizados son una causa de morbimortalidad prevenible y evitable, generan costos económicos y afectan calidad de vida, se justifica evaluar esta problemática en términos de resultados clínicos. El objetivo de este estudio es caracterizar la población de Cali con lesiones relacionadas con colisiones de vehículos motorizados que fueron atendidos en los servicios de urgencias de dos centros de alta complejidad de la ciudad. Materiales y métodos Estudio observacional descriptivo, utilizando un registro de trauma en dos hospitales de alta complejidad de Cali, Colombia. Resultados En un periodo de 8 meses 11889 atenciones secundarias a lesiones de causas externas intencionales y no intencionales fueron registradas. Del total de pacientes, 1395 (11,6%) tenían lesión de tránsito, y de estos el 86% (n = 1200) ingresaron con escala de severidad de trauma (ISS) <9. El 48,4% (n = 675) de las atenciones estu...

The journal of trauma and acute care surgery, 2012

Early damage-control resuscitation (DCR) indicators have not been clearly discerned in patients w... more Early damage-control resuscitation (DCR) indicators have not been clearly discerned in patients with penetrating abdominal trauma. Our objective was to identify these clinical indicators that could standardize a DCR initiation policy in this subset of patients. Prospective data collection from January 2003 to October 2010 at a Level I trauma center in Cali, Colombia. All adult (>15 years) patients with abdominal gunshot wounds (GSWs) were included. They were divided into two groups: those who underwent DCR and those who did not. Both groups were compared by demographics, clinical variables, severity scores, and overall mortality. Other scores were compared with our newly devised model using the area under the receiver operating characteristic curve (AUROC). There was a total of 331 abdominal GSWs. Of these, a total of 162 (49%) underwent DCR. The overall mortality was 11.2%. Multivariate analysis identified (A) acidosis (base deficit ≥ 8); (B) blood loss (hemoperitoneum > 1,50...

The journal of trauma and acute care surgery, 2013

The objective of this study was to describe a comprehensive five-step surgical management approac... more The objective of this study was to describe a comprehensive five-step surgical management approach for patients with penetrating liver trauma based on our collective institutional experience. A prospective consecutive study of all penetrating liver traumas from January 2003 to December 2011 at a regional Level I trauma center in Cali, Colombia, was conducted. A total of 538 patients with penetrating thoracoabdominal trauma were operated on at our institution. Of these, 146 had penetrating liver injuries that satisfied the inclusion criteria for surgical intervention to manage their hepatic and/or associated injuries. Eighty-eight patients (60%) had an American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) of Grade III (54 patients, 37%), Grade IV (24 patients, 16%), and Grade V (10 patients, 7%). This group of patients required advanced "complex" techniques of hemostasis such as the Pringle maneuver (PM), perihepatic liver packing (PHLP), and/or hepat...

The journal of trauma and acute care surgery, 2014

The traditional management of complex penetrating duodenal trauma (PDT) has been the use of elabo... more The traditional management of complex penetrating duodenal trauma (PDT) has been the use of elaborate temporizing and complex procedures such as the pyloric exclusion and duodenal diverticulization. We sought to determine whether a simplified surgical approach to the management of complex PDT injuries improves clinical outcome. A retrospective review of all consecutive PDT from 2003 to 2012 was conducted. Patients were divided into three groups according to a simplified surgical algorithm devised following the local experience at a regional Level I trauma center. Postoperative duodenal leaks were drained externally either via traditional anterior drainage or via posterior "retroperitoneal…

World Journal of Surgery, 2012

Abdominal packing (AP) in damage-control laparotomy (DCL) is a lifesaving technique that controls... more Abdominal packing (AP) in damage-control laparotomy (DCL) is a lifesaving technique that controls coagulopathic hemorrhage in severely injured trauma patients. However, the impact of the duration of AP on the incidence of re-bleeding and on intra-abdominal infections in penetrating abdominal trauma is not clear. The objective of the present study was to evaluate the complications related to the duration of AP and to determine the optimal time for AP removal. Prospectively collected/retrospectively analyzed data at an urban level I trauma center from January 2003 to December 2010 were used as the basis for this study. Inclusion criteria were adults (≥18 years old) with penetrating abdominal trauma, who had survived both the initial DCL procedure and their first re-laparotomy. All initial DCL patients included in the study underwent abdominal packing for coagulopathic hemorrhage control. The outcome measures of this study were re-bleeding after packing removal, intra-abdominal infection, and 30-day cumulative mortality. We considered time after packing as an independent variable. This was defined as the total amount of time (in days) that the packs were left in the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s abdomen. Patients were grouped according to the duration in days of their AP in…

The Journal of Trauma: Injury, Infection, and Critical Care, 2011

Background-Recent studies report the safety and feasibility of performing delayed anastomosis (DA... more Background-Recent studies report the safety and feasibility of performing delayed anastomosis (DA) in patients undergoing damage control laparotomy (DCL) for destructive colon injuries (DCI). Despite accumulating experience in both civilian and military trauma, questions regarding how to best identify high risk patients and minimize the number of anastomosisassociated complications remain. Our current practice is to perform a definitive closure of the colon during DCL, unless there is persistent acidosis, bowel wall edema, or evidence of intraabdominal abscess. In this study, we evaluated the safety of this approach by comparing outcomes of patients with DCI who underwent definitive closure of the colon during DCL versus patients managed with colostomy with or without DCL. Methods-We performed a retrospective chart review of patients with penetrating DCI during 2003-2009. Severity of injury, surgical management, and clinical outcome were assessed. Results-Sixty patients with severe gunshot wounds (GSW) and 3 patients with stab wounds were included in the analysis. DCL was required in 30 patients, all with GSW. Three patients died within the first 48 hours, 3 underwent colostomy, and 24 were managed with DA. Thirty-three patients were managed with standard laparotomy: 26 patients with primary anastomosis, and 7 with colostomy. Overall mortality rate was 9.5%. Three late deaths occurred in the DCL group, and only one death was associated with an anastomotic leak. Conclusions-Performing a DA in DCI during DCL is a reliable and feasible approach as long as severe acidosis, bowel wall edema, and/or persistent intra-abdominal infections are not present.

Rev. colomb. …, 2009

Revista Colombiana …, 2009

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Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2013

Introducción: Colombia es uno de los países con más morbimortalidad secundaria a lesiones por vio... more Introducción: Colombia es uno de los países con más morbimortalidad secundaria a lesiones por violencia. Se esperaría que este fenómeno se refleje en todos los grupos de edad. Sin embargo no se ha descrito que sucede en la población del adulto mayor. El objetivo fue describir la tendencia del trauma en la población que consulta a dos hospitales de referencia en Cali. Materiales y métodos: Entre enero y abril de 2012 se implementó el piloto del

Rev. Col. Bras. Cir., 2012

Objetivo: Describir la experiencia en la implementación de un Sistema de Registro de Trauma (SRT)... more Objetivo: Describir la experiencia en la implementación de un Sistema de Registro de Trauma (SRT) en dos hospitales en Cali, Colombia. Métodos: El SRT incluye información prehospitalaria, hospitalaria y estatus de egreso del paciente. Cada hospital tiene una estrategia para la captura electrónica de datos. Se presenta un análisis descriptivo exploratorio durante un piloto de tres meses. Resultados: Se han registrado 3293 pacientes, 1626(49.4%) del Hospital Público y 1613(50.6%) en el Privado. 67.2% fueron hombres; edad promedio 30,5±20 años, 30,5% menores de 18 años. Mortalidad global 3,52 %. Causa más frecuente de consulta fueron las caídas (33,7%); 11.6% fueron heridas por arma de fuego, la mortalidad en este grupo fue del 44.7%. Conclusión: Se determinaron las necesidades para la implementación del SRT y los mecanismos para darle continuidad. El registro se convierte en una fuente de información para el desarrollo de la investigación. Se identificaron las causas de consulta, morbilidad y muerte por trauma que permitirá una mejor planeación de los servicios de urgencias y del sistema regional de trauma con el fin de optimizar y de reducir los costos de atención. A partir de este sistema de información de trauma se podrán plantear los ajustes indispensables para rediseñar el sistema de trauma y emergencias del suroccidente colombiano.

Background: Junctional vascular trauma such as that at the thoracic outlet poses particular chall... more Background: Junctional vascular trauma such as that at the thoracic outlet poses particular challenges in surgical management. The use of endovascular techniques for such injuries is attractive as repair may be facilitated without the need for thoracotomy; however, the utility of such techniques is currently based on opinion, small retrospective series, and literature reviews of narrative and not systematic quality. The objective of this study is to provide a complete and systematic analysis of the literature pertaining to open surgery (OS) and endovascular management (EM) of thoracic outlet vascular injuries. Methods: An electronic search using the MEDLINE, Embase, Cochrane Library, Science Citation Index, and LILACS databases was performed for articles published from 1947 to November 2011. The review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement standards. Prospective studies and retrospective cohorts of more than 10 patients were included. The primary outcome was all-cause mortality. Results: One prospective noncomparative study and 73 retrospective series met the inclusion criteria. There were no randomized studies. All studies were at high risk of bias. Fifteen studies described outcomes for both OS and EM (549 patients). The majority of these studies described EM for traumatic arteriovenous fistulas or false aneurysms in stable patients. Direct comparison between OS and EM was possible in only three studies (comprising 23 OS and 25 EM patients), which showed no difference in all-cause mortality (odds ratio, 0.67; 95% confidence interval [CI], 0.11-4.05), but a shorter operating time with EM (mean difference [ 58.34 minutes; 95% CI, 17.82-98.85). These three series included successful EM of unstable patients and those with vessel transection. There were 55 studies describing only OS (2057 patients) with a pooled mortality rate of 12.4% (95% CI, 9.9%-15.2%). Four studies described only EM (101 patients) with a pooled mortality rate of 26% (95% CI, 8%-51%), but these represented a distinct subgroup of cases (mainly iatrogenic injuries in older patients). Conclusions: The current evidence is weak and fails to show superiority of one modality over the other. EM is currently used primarily in highly selected cases, but there are reports of a broader applicability in trauma. High-quality randomized studies or large-scale registry data are needed to further comment on the relative merits or disadvantages of EM in comparison to OS. (J Vasc Surg 2013;57:547-67.)