Approach to major abdominal vascular injury

Abdominal vascular injuries account for 25% to 30% of all vascular injuries seen in urban trauma centers where penetrating wounds are the most common cause of trauma. Patients have moderate hypotension if contained hematomas are present and present in extremis with massive abdominal distension, if hemorrhage into the peritoneal cavity is occurring. Injuries occur in five areas, each containing its own vessels and techniques of exposure and vascular repair. Included are the midline supramesocolic, midline inframesocolic, lateral perirenal, lateral pelvic, and portal areas. In these areas, arterial repair is essentially always attempted, whereas ligation of major veins, if necessary, is well tolerated in many instances. Survival depends on the number and magnitude of associated vascular and visceral injuries. If an operation can be performed soon after injury, survival with most major abdominal arterial injuries ranges from 35% to 85%. When major abdominal venous injuries are considered, the survival rate ranges from 50% to 95%. Postoperative complications include thrombosis of repairs, dehiscence of suture lines, and infection. Second-look operations may be beneficial to evaluate tenuous repairs, whereas various techniques are helpful in avoiding suture line breakdowns as a result of infection.