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Abdominal vascular injuries

Abdominal vascular injuries. Prof TV Mulaudzi. Abdominal vascular injuries. The most common cause of death following penetrating abdominal trauma. Incidence and Epidemiology. In patients undergoing laparotomy Gunshot wounds (Civilian) = 14% Stabwounds = 10% Blunt trauma = 3 %.

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Abdominal vascular injuries

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  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%

  4. 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%

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

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

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

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

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

  10. Operative management • Penetrating 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

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

  12. 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

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

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

  15. Abdominal vascular trauma Early intervention saves life

  16. THANK YOU

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