Abdominal vascular trauma

Abstract

Abdominal vascular trauma, primarily due to penetrating mechanisms, is uncommon. However, when it does occur, it can be quite lethal, with mortality ranging from 20% to 60%. Increased early mortality has been associated with shock, acidosis, hypothermia, coagulopathy, free intraperitoneal bleeding and advanced American Association for the Surgery of Trauma Organ Injury Scale grade. These patients often arrive at medical centers in extremis and require rapid surgical control of bleeding and aggressive resuscitation including massive transfusion protocols. The most important factor in survival is surgical control of hemorrhage and restoration of appropriate perfusion to the abdominal contents and lower extremities. These surgical approaches and the techniques of definitive vascular repair can be quite challenging, particularly to the inexperienced surgeon. This review hopes to describe the most common abdominal vascular injuries, their presentation, outcomes, and surgical techniques to control and repair such injuries.

Retrohepatic IVC injury: A new treatment approach with arterial stent graft

“…Distance of the injury from the heart is also a strong prognostic factor [5] . IVC injuries affecting the infrarenal IVC carry the best-reported survival rate due to relatively easy access for ligation with a reported mortality rate of 23% [2 , 6] . Injury to the retrohepatic segment of the IVC, on the other hand, carries a poor prognosis with 78% reported mortality rate, largely due to associated severe hepatic injury and difficulty gaining good exposure to that region for bleeding control.…”

“…Inferior vena cava injuries are usually classified by location as infrarenal, suprarenal and retrohepatic. Classically, traumatic injuries to the IVC are repaired surgically and several surgical repair techniques have been established for management of IVC injury based on the injury location and presence of free bleeding versus contained hematoma [2] . However, there are few case reports of successful endovascular management of the injury depending on the patient's condition [3] .…”

Hematomas in Tiger Territory

“…5 Zone 2 is variously defined as "paracolic gutters bilaterally" or "upper lateral retroperitoneum." 6,7 The emphasis is that this zone contains the kidney and associated vasculature, although it is common that the hematoma extends medially into zone 1 and not uncommonly descends into zone 3. As with the management of penetrating trauma, once a laparotomy is performed, the current emphasis has been to mandate exploration of zone 2 after penetrating trauma, with first controlling the renal vessels and/or rotating the colon medially.…”

“…As with the management of penetrating trauma, once a laparotomy is performed, the current emphasis has been to mandate exploration of zone 2 after penetrating trauma, with first controlling the renal vessels and/or rotating the colon medially. 6,7 However, after the experience with blunt trauma, it has been suggested that in stable patients, with "small" perirenal hematomas, nonoperative management/observation may be permitted. 6 The mortality associated with abdominal vascular trauma varies with number of vessels injured and patient stability.…”

Liver trauma: WSES 2020 guidelines

“…If the bleeding comes from behind the liver, retro-hepatic caval or hepatic vein injury should be highly suspected [34,77]. Three viable options exist for the management of retrohepatic caval/ suprahepatic venous injuries: (1) tamponade with hepatic packing, (2) direct repair (with or without vascular isolation), and (3) lobar resection [38,[78][79][80]. Liver packing is the least risky method to temporarily deal with severe venous injuries [34,66,[81][82][83].…”