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Abdominal vascular injuries

Abdominal vascular injuries

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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