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Abdominal Vascular Trauma

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Textbook of Emergency General Surgery

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Abstract

Background: Abdominal vascular injuries (AVI) are rare, most commonly occurring after penetrating trauma except among pediatric patients and most frequently impact young adult males. AVI continue to be associated with extremely high morbidity and mortality and are often associated with concomitant intra-abdominal as well as extra-abdominal injuries such as traumatic brain, spinal, and thoracic injuries.

Methods: This chapter was based on an extensive literature search and utilized published guidelines on abdominal vascular trauma from the American Association for the Surgery of Trauma (AAST), the World Society of Emergency Surgery (WSES), and Western Trauma Association (WTA).

Diagnosis: Patients with hemodynamic instability after penetrating or blunt abdominal or pelvic trauma need urgent surgical exploration for both diagnosis and treatment. In stable patients, physical exams, laboratory, and imaging findings can help with diagnosis. The mainstay of AVI diagnosis in hemodynamically stable asymptomatic patients is computed tomography angiography (CTA).

Treatment: Open surgical repair remains the mainstay for AVI treatment. Proximal and distal control of vascular injuries with appropriate exposure is critical for surgical treatment. In very select cases with isolated AVI from blunt trauma, endovascular repair is a viable option.

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Further Reading

  • Feliciano D, Moore E, Biffl W. Western Trauma Association Critical Decisions in Trauma: management of abdominal vascular trauma. J Trauma Acute Care Surg. 2015;79(6):1079–88.

    Article  PubMed  Google Scholar 

  • Kobayashi L, Coimbra R, Goes AMO Jr, Reva V, Santorelli J, et al. American Association for the Surgery of Trauma–World Society of Emergency Surgery guidelines on diagnosis and management of abdominal vascular injuries. J Trauma Acute Care Surg. 2020;89(6):1197–211.

    Article  PubMed  Google Scholar 

  • Pereira BMT, Chiara O, Ramponi F, Weber DG, Cimbanassi S, De Simone B, et al. WSES position paper on vascular emergency surgery. World J Emerg Surg. 2015;10:49.

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Authors and Affiliations

  1. University of California San Diego, San Diego, CA, USA

    Franchesca J. Hwang, Jarrett E. Santorelli & Leslie M. Kobayashi

  2. Riverside University Health System Medical Center, Loma Linda University School of Medicine, Moreno Valley, CA, USA

    Raul Coimbra

Authors
  1. Franchesca J. Hwang
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  2. Jarrett E. Santorelli
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  3. Leslie M. Kobayashi
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  4. Raul Coimbra
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Corresponding author

Correspondence to Raul Coimbra .

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Editors and Affiliations

  1. General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Pisa, Italy

    Federico Coccolini

  2. General and Emergency Surgery Dept., Bufalini Hospital, Cesena, Italy

    Fausto Catena

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Hwang, F.J., Santorelli, J.E., Kobayashi, L.M., Coimbra, R. (2023). Abdominal Vascular Trauma. In: Coccolini, F., Catena, F. (eds) Textbook of Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-22599-4_100

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  • DOI: https://doi.org/10.1007/978-3-031-22599-4_100

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