WSES position paper on vascular emergency surgery

Abstract

Trauma, both blunt and penetrating, is extremely common worldwide, as trauma to major vessels. The management of these patients requires specialized surgical skills and techniques of the trauma surgeon. Furthermore few other surgical emergencies require immediate diagnosis and treatment like a ruptured abdominal aortic aneurysm (rAAA). Mortality of patients with a rAAA reaches 85 %, with more than half dying before reaching the hospital. These are acute events demanding immediate intervention to save life and limb and precluding any attempt at transfer or referral. It is the purpose of this position paper to discuss neck, chest, extremities and abdominal trauma, bringing to light recent evidence based data as well as expert opinions; besides, in this paper we present a review of the recent literature on rAAA and we discuss the rationale for transfer to referral center, the role of preoperative imaging and the pros and cons of Endoluminal repair of rAAA (REVAR) versus Open Repair (OR).

Keywords: Ruptured abdominal aorta aneurism; Trauma; Vascular Trauma: Neck, Chest and Extremities; Vascular control; Vascular injuries.

Fig. 1

Glass-coated kite line zone II neck injury

Fig. 2

Zones of superior mesenteric artery: angiographic view was excluded

Fig. 3

a Abdominal CT with IV contrast of a patient with symptomatic AAA. b Non-contrast abdominal CT of the same patient after collapse about 2 h later. The AAA ruptured as is evident from the retroperitoneal hematoma

Fig. 4

Abdominal CT with IV contrast demonstrating a large infrarenal AAA ruptured in the inferior vena cava in axial and sagittal view

Fig. 5

3D reconstruction of large infrarenal AAA ruptured into the inferior vena cava

Fig. 6

Flowchart of the rAAA protocol introduced by the Albany Group [80]

Fig. 7

Flowchart of the STAT VASCULAR program from the University of Illinois [82]