Abdominal vascular injuries

Trauma surgeons are occasionally faced with patients with abdominal vascular injuries. Important surgical issues in the successful management of these injuries require a thorough knowledge of the abdominal vascular anatomy and techniques of vascular repair, that surgical exploration be performed without delay, that the vascular injury be exposed rapidly with control of hemorrhage upon entering the abdomen, that efforts be made to reestablish perfusion initially to the structures at the highest risk of anoxic injury, and an understanding that it is occasionally necessary to perform temporary procedures while the general condition of a patient is being stabilized, with subsequent definitive care. The primary goal in the management of these patients should be hemorrhage control rather than maintenance of blood flow. The principles of abbreviated laparotomy with planned reoperation should be used in some patients with major abdominal vascular injuries. The decision to reestablish vascular continuity at a later time should balance anticipated functional outcome against potential complications.