1. Abdominal vascular injuries
Prof TV Mulaudzi

2. Abdominal vascular injuries
The most common cause of death following penetrating abdominal trauma

3. Incidence and Epidemiology
In patients undergoing laparotomy
Gunshot wounds (Civilian) = 14%
Stabwounds = 10%
Blunt trauma = 3%

5. Incidence and Epidemiology
Incidence similar for arterial and venous
IVC = 25% of injuries
Aorta = 21%
Iliac artery = 20%
Iliac veins = 17%
SMV = 11%
SMA = 10%

6. Prehospital management
Rapid transportation to hospital for immediate surgical control of bleeding
Controlled hypotension is beneficial
Prevents massive exsanguination

7. Clinical presentation
Major abdominal vascular injuries  many die at the scene
Depends on injured vessel, size & type of injury, associated injuries and prehospital time

8. Investigations Mostly  Immediate laparotomy
Diagnosis mostly intra-operatively
Stable pt’s  CXR & AXR
 CT scan

9. Emergency department management
Large bore IV catheters in
Upper extremities or
Central veins of thoracic inlet
Controlled hypotension

10. Operative management General principles Diminish hypothermia
Warm operating room
Pre-warm infused fluids to 40-42°
Cover extremities with warm blankets
Rapid infusion devices

12. Operative management Penetrating trauma Blunt trauma
Explore all hematomas irrespective of size
Blunt trauma
Retroperitoneal hematoma rarely require exploration  low incidence of vascular or hollow viscus injuries requiring repair
Exceptions:
*Expanding, pulsatile or leaking hematomas
*Absent ipsilateral femoral pulse in Zone 3
*Para-duodenal hematomas

15. Damage control procedures
Early damage control and definitive reconstruction at a later stage
Massive blood transfusions
Hypotensive
Severely hypothermic
Acidotic
Coagulopathic intraoperative
Complex venous injuries are ligated
Arterial injuries may be shunted
Diffuse retroperitonal or parenchymal bleedingtight gauze packing
ICU for resuscitationstabilizereturn to OR

17. Specific vascular injuries
Abdominal aorta:
Penetrating injuries by far most common
Many die at the scene
Temporarily contained in the retroperitoneum
Blunt injury is extremely rare, usually due to MVA’s, direct blows, falls, exposions
Rarely injury missed and presents later as pseudoaneurysm or AV-fistula

19. Abdominal aorta Management Operative Endovascular  selected cases
Primary or prosthetic graft repair
Endovascular  selected cases
Infrarenal dissection, false aneurysms, or aortocaval fistulae

20. Abdominal aorta Mortality Blunt trauma: Overall mortality 27%
Penetrating trauma: 67%
Suprarenal worse than infrarenal

21. Abdominal vascular trauma
Early intervention saves life

22. THANK YOU