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. 2016 Jul 20;1(1):e000015.
doi: 10.1136/tsaco-2016-000015. eCollection 2016.

Abdominal vascular trauma

Leslie M Kobayashi  1 , Todd W Costantini  1 , Michelle G Hamel  1 , Julie E Dierksheide  1 , Raul Coimbra  2
Affiliations

Abdominal vascular trauma

Leslie M Kobayashi et al. Trauma Surg Acute Care Open. .

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.

Keywords: abdominal; injury and trauma; vascular.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Exposure of the suprarenal aorta following left medial visceral rotation. Note the dense connective tissue that surrounds the supraceliac aorta, identified by displacing the gastro-oesophageal junction anteriorly.
Figure 2
Figure 2
Exposure of the infrarenal, juxta-renal, and suprarenal IVC following right-sided medial visceral rotation. The exposure of the suprarenal IVC is obtained by displacing the inferior edge of the right lobe of the liver superiorly and after performing an extended Kocher maneuver. IVC, inferior vena cava.
Figure 3
Figure 3
Lateral venorrhaphy of infrarenal IVC causing critical narrowing >40%. IVC, inferior vena cava.
Figure 4
Figure 4
Prosthetic graft patch repair of IVC injury, preventing narrowing of the IVC lumen in a through-and-through gunshot wound. The posterior defect was repaired primarily after extending the anterior defect. IVC, inferior vena cava.
Figure 5
Figure 5
Ligated infrarenal IVC injury. IVC, inferior vena cava.
Figure 6
Figure 6
Retrohepatic IVC exposed by partial hepatectomy. IVC, inferior vena cava.
Figure 7
Figure 7
Looped temporary intravascular shunt within the iliac artery.
See this image and copyright information in PMC

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