Management of Penetrating Trauma to the Major Abdominal Vessels

Abstract

Penetrating abdominal vascular injuries result in significant mortality. In the pre-hospital phase of care, Bscoop and run^is the optimal strategy while on-scene interventions are restricted only to basic airway maneuvers. Early in-hospital diagnosis and operative interventions are prerequisites for survival in vascular trauma. Hypotension and peritonitis following penetrating abdominal trauma mandate immediate access to the operating room with vascular surgery capabilities. Patients presenting in extremis should be managed with a resuscitative thoracotomy in the emergency department. The majority of abdominal vascular injuries surviving to the operating room are subjected to damage control intervention. In hemodynamically stable patients, diagnostic modality of choice is computed tomography angiography and endovascular interventions are evolving.

Superior Mesenteric Artery and Vein Injuries: Operative Strategies and Outcomes

“…11 These principles were originally described over a century ago, particularly in military theaters, and even today in the damage control setting, shunting may be the most prudent option. 12,13 Still, more contemporary studies have also shown endovascular interventions to be a potentially efficacious adjunct to delayed repair surgery.…”