Abdominal and Peripheral Vascular Injuries: Critical Decisions in Trauma

Abstract

Abdominal trauma that results in vascular injuries is associated with high mortality rates. Survival is dependent on early diagnosis and rapid intervention. Detailed knowledge of the operative approach to the aorta, iliac vessels, and visceral branches is required if rapid control of bleeding is to be achieved. Endovascular techniques have evolved and continue to evolve, with embolotherapy providing an alternative or, in some cases, an adjunct to operative treatment. Patients are best managed in experienced trauma centers and multidisciplinary teams where the resuscitation room, computed tomography (CT) suite, operating theater, and interventional radiology room all lie within close proximity. Venous abdominal trauma injury is uncommon and primary repair is preferred. When the patient’s physiologic status will not tolerate prolonged repair or when the injury is too extensive, ligation is an acceptable alternative.

Injuries to blood vessels in the upper extremity continue to present significant challenges to trauma and vascular surgeons. Vascular trauma in the upper limb may result not only in life-threatening hemorrhage but also in tissue ischemia, leading to ischemic neuropathy/plexopathy, compartment syndromes, and muscular contracture. The best chance of successful management lies in early clinical review, correct application of damage-control principles, proper use of diagnostic technologies, and efficient judgment as to the optimal treatment strategy. As in other areas of vascular trauma, the use of endovascular technologies is becoming ever-more feasible to stop hemorrhage and to restore vessel perfusion, even beyond the root of the limb. Vascular trauma of the lower extremities is associated with high rates of morbidity and mortality and is especially challenging when it involves the junctional zone between the torso and the lower extremities. The successful management of lower extremity vascular injury is dependent on early diagnosis and control of hemorrhage, resuscitation of the patient, and prompt intervention to minimize associated ischemia.