Abdominal vascular injuries

Prof TV Mulaudzi

Abdominal vascular injuries

The most common cause of death following penetrating

abdominal trauma

Incidence and Epidemiology

In patients undergoing laparotomy Gunshot wounds (Civilian) = 14% Stabwounds = 10% Blunt trauma = 3%

Incidence similar for arterial and venous

IVC = 25% of injuries Aorta = 21% Iliac artery = 20% Iliac veins = 17% SMV = 11% SMA = 10%

Incidence and Epidemiology

Prehospital management Rapid transportation to hospital for

immediate surgical control of bleeding

Controlled hypotension is beneficial Prevents massive exsanguination

Clinical presentation

Major abdominal vascular injuries many die at the scene

Depends on injured vessel, size & type of injury, associated injuries and prehospital time

Investigations

Mostly Immediate laparotomy Diagnosis mostly intra-operatively Stable pt’s CXR & AXR

CT scan

Emergency department management

Large bore IV catheters in Upper extremities or Central veins of thoracic inlet

Controlled hypotension

Operative management General principles

Diminish hypothermia Warm operating room Pre-warm infused fluids to 40-42° Cover extremities with warm blankets

Rapid infusion devices

Operative management Penetrating trauma

Explore all hematomas irrespective of size Blunt trauma

Retroperitoneal hematoma rarely require exploration low incidence of vascular or hollow viscus injuries requiring repair

Exceptions:*Expanding, pulsatile or leaking hematomas*Absent ipsilateral femoral pulse in Zone 3*Para-duodenal hematomas

Damage control procedures Early damage control and definitive

reconstruction at a later stage Massive blood transfusions Hypotensive Severely hypothermic Acidotic Coagulopathic intraoperative

Complex venous injuries are ligated Arterial injuries may be shunted Diffuse retroperitonal or parenchymal

bleedingtight gauze packing ICU for resuscitationstabilizereturn to OR

Specific vascular injuries Abdominal aorta:

Penetrating injuries by far most common Many die at the scene Temporarily contained in the retroperitoneum

Blunt injury is extremely rare, usually due to MVA’s, direct blows, falls, exposions

Rarely injury missed and presents later as pseudoaneurysm or AV-fistula

Abdominal aorta Management

Operative Primary or prosthetic graft repair

Endovascular selected cases Infrarenal dissection, false aneurysms, or

aortocaval fistulae

Abdominal aorta Mortality

Blunt trauma: Overall mortality 27% Penetrating trauma: 67% Suprarenal worse than infrarenal

Abdominal vascular trauma

Early intervention saves life

THANK YOU