Management of injuries to the suprarenal aorta

Accola, Kevin D.; Feliciano, David V.; Mattox, Kenneth L.; Bitondo, Carmel G.; Burch, Jon M.; Beall, Arthur C.; Jordan, George L.

doi:10.1016/0002-9610(87)90227-3

Cited by 31 publications

(22 citation statements)

References 31 publications

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“…The prognosis is better in case of blunt abdominal aortic trauma compared to penetrating trauma ( 37 ). Overall mortality after blunt and penetrating aortic injuries is estimated at 30 and 85%, respectively ( 37 , 83 , 84 ).…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

“…Several studies on SMA injuries have been conducted at experienced trauma centers ( 1 , 84 , 87 , 91 – 93 , 104 – 115 ) (Table 2 ). Since Fullen et al ( 115 ) proposed an anatomic classification of injuries to the SMA, their management depends on the level of injury.…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

“…However, these zones are characterized by high level of surgical difficulties, and under active bleeding in an unstable patient, the use of intraluminal shunt into the debrided ends of SMA should be considered. If the patient is stable and the proximal part of the SMA should be replaced, saphenous vein or prosthetic grafts have been described ( 84 ). On the other hand, injuries in zones III (distal to middle colic artery) and IV (the segmental intestinal branches) should be approached directly without any additional surgical manipulation.…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

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Contemporary Strategies in the Management of Civilian Abdominal Vascular Trauma

et al. 2018

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The evaluation and management of patients with abdominal vascular trauma or injury requires immediate and effective decision-making in these unfavorable circumstances. The majority of these patients arrive at trauma centers in profound shock, secondary to massive blood loss, which is often unrelenting. Moreover, ischemia, compartment syndrome, thrombosis, and embolization may also be life threatening and require immediate intervention. To minimize the risk of these potentially lethal complications, early understanding of the disease process and emergent therapeutic intervention are necessary. In the literature, the management of acute traumatic vascular injuries is restricted to traditional open surgical techniques. However, in penetrating injuries surgeons often face a potentially contaminated field, which renders the placement of prosthetic grafts inappropriate. Currently, however, there are sparse data on the management of vascular trauma with endovascular techniques. The role of endovascular technique in penetrating abdominal vascular trauma, which is almost always associated with severe active bleeding, is limited. It is worth mentioning that hybrid operating rooms with angiographic radiology capabilities offer more opportunities for the management of this kind of injuries by either temporary control of the devastating bleeding using endovascular balloon tamponade or with embolization and stenting. On the other hand, blunt abdominal injuries are less dangerous and they could be treated at most times by endovascular means. Since surgeons continue to encounter abdominal vascular trauma, open and endovascular techniques will evolve constantly giving us encouraging messages for the near future.

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Section: Diagnostic Evaluationmentioning

confidence: 99%

Section: Diagnostic Evaluationmentioning

confidence: 99%

Section: Diagnostic Evaluationmentioning

confidence: 99%

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Contemporary Strategies in the Management of Civilian Abdominal Vascular Trauma

et al. 2018

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“…10 Similarly, Degiannis et al reported survival in 50% (6 of 12) of patients with retroperitoneal tamponade, whereas only 4.4% (2 of 45) survived with hemoperitoneum at presentation 5 ; several additional studies have demonstrated similar results. 4,15,16 These factors likely contribute to the overall high mortality rate with PAAI, and the similarity in mortality rate seen in patients treated at either level-I or level-II trauma centers. However, as demonstrated by MacKenzie et al, patients who are treated at trauma centers, in general, have a lower overall mortality rate than those treated at non-trauma centers.…”

Section: Discussionmentioning

confidence: 99%

Penetrating Abdominal Aortic Injury: Comparison of ACS-Verified Level-I and II Trauma Centers

Sheehan

Grigorian

Maithel

et al. 2020

Vasc Endovascular Surg

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Objectives: Penetrating abdominal aortic injury (PAAI) is a highly acute injury requiring prompt surgical management. When compared to surgeons at level-II trauma centers, surgeons at level-I trauma centers are more likely to take in-house call, and may more often be available within 15 minutes of patient arrival. Thus, we hypothesized that level-I trauma centers would have a lower mortality rate than level-II trauma centers in patients with PAAI. Methods: We queried the Trauma Quality Improvement Program database for patients with PAAI, and compared patients treated at American College of Surgeons (ACS)-verified level-I centers to those treated at ACS level-II centers. Results: PAAI was identified in 292 patients treated at level-I centers and 86 patients treated at level-II centers. Patients treated at the 2 center types had similar median age, injury severity scores and prevalence of diabetes, hypertension, and smoking (p > 0.05). There was no difference in the frequency of additional intra-abdominal vascular injuries (p > 0.05). Median time to hemorrhage control (level-I: 40.8 vs level-II: 49.2 minutes, p = 0.21) was similar between hospitals at the 2 trauma center levels. We found no difference in the total hospital length of stay or post-operative complications (p > 0.05). When controlling for covariates, we found no difference in the risk of mortality between ACS verified level-I and level-II trauma centers (OR:1.01, CI:0.28-2.64, p = 0.99). Conclusion: Though the majority of PAAIs are treated at level-I trauma centers, we found no difference in the time to hemorrhage control, or the risk of mortality in those treated at level-I centers when compared to those treated at level-II trauma centers. This finding reinforces the ACS-verification process, which strives to achieve similar outcomes between level-I and level-II centers.

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“…Penetrating subdiaphragmatic aortic trauma is associated with incredibly high morbidity and mortality with previous studies having reported approximately 50%-70% associated mortality. 1 , 2 , 3 , 4 , 5 , 6 Patients who are fortunate enough to arrive alive at the hospital with these injuries, can be diagnosed clinically with confirmatory radiologic studies such as computed tomography angiography. Prompt identification of the mechanism of injury, concomitant injuries, and, if indicated, surgical treatment are paramount to achieving a successful outcome.…”

mentioning

confidence: 99%