Major abdominal vascular trauma--a unified approach

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Emergency Medicine

Background:

• Prehospital care advances lead to more patients with severe trauma arriving at hospitals.
• Major abdominal vascular injuries pose significant challenges in emergency settings.

Purpose of the Study:

• To review a 6-year experience with major abdominal vascular injuries.
• To analyze injury patterns, mortality, and survival factors.

Main Methods:

• Retrospective review of 123 patients with 161 major abdominal vascular injuries over 6 years.
• Analysis of injury site distribution, mortality rates, and resuscitation techniques.
• Evaluation of factors influencing survival, including coagulopathy, hypothermia, and acidosis.

Main Results:

• Overall mortality was 37%.
• Specific injury sites had varying mortality rates (aortic: 56%, IVC: 39%, portal venous system: 39%).
• Survival rates improved when aortic occlusion was performed in the operating room versus the emergency department (35% vs. 7%).
• Patients with multiple injuries had lower survival rates (39%) compared to single injuries (76%).
• While 89% of mortality was due to bleeding, half of deaths occurred post-bleeding control, indicating the impact of complicating factors.

Conclusions:

• Hemorrhage is the primary cause of death, but coagulopathy, hypothermia, and acidosis are critical complicating factors.
• Effective resuscitation and operative control must be complemented by managing these physiological derangements.
• Improved survival necessitates a comprehensive approach addressing both initial trauma and subsequent metabolic disturbances.