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Iliac vessel injuries
James T Lee1, Frederic S Bongard
1Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA. jtlee@humc.edu
Insights
Managing iliac vascular trauma is challenging, with high mortality from bleeding and associated injuries. This review covers current strategies, PTFE use in contaminated fields, and the emerging role of endovascular techniques.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Surgical Management
Background:
- Iliac vascular trauma presents significant management challenges.
- Penetrating injuries to this region are associated with high mortality rates, often approaching 40% in reported series.
- Uncontrollable hemorrhage and associated injuries contribute to the high mortality.
Purpose of the Study:
- To discuss current management strategies for iliac vascular trauma.
- To review the controversial use of polytetrafluoroethylene (PTFE) grafts in contaminated surgical fields.
- To address concomitant injuries and postoperative care, including anticoagulation and fasciotomy complications.
Main Methods:
- Review of existing literature on iliac vascular trauma management.
- Discussion of surgical reconstruction techniques, including the use of PTFE grafts.
- Exploration of adjunctive endovascular therapies.
Main Results:
- High mortality rates persist for penetrating iliac vascular injuries.
- The use of PTFE in contaminated fields remains controversial.
- Endovascular therapy is emerging as a valuable adjunctive tool.
Conclusions:
- Effective management of iliac vascular trauma requires a comprehensive approach.
- Careful consideration of graft material and surgical field contamination is crucial.
- Integration of endovascular techniques can improve outcomes for trauma surgeons.
Abstract:
Trauma to the iliac vasculature continues to pose a significant challenge to management. In several large series, mortality for penetrating injuries is reported as approaching 40%. Uncontrollable hemorrhage originating from an anatomically inaccessible source and multiple associated injuries often contribute to this high mortality rate. This article discusses the current existing management strategies and the controversial role of PTFE in vascular reconstruction within a contaminated field. Concomitant injuries to the enteric viscera and genitourinary system are also addressed. Postoperative management including anticoagulation and the complications of liberal fasciotomy are mentioned. The evolving role of endovascular therapy as an adjunctive modality in the armamentarium of the trauma surgeon is also presented briefly.