Abdominal
vascular injuries account for 25% to 30% of all
vascular injuries seen in urban trauma centers where
penetrating wounds are the most common cause of
trauma. Patients have moderate
hypotension if contained
hematomas are present and present in extremis with massive abdominal distension, if
hemorrhage into the peritoneal cavity is occurring.
Injuries occur in five areas, each containing its own vessels and techniques of exposure and vascular repair. Included are the midline supramesocolic, midline inframesocolic, lateral perirenal, lateral pelvic, and portal areas. In these areas, arterial repair is essentially always attempted, whereas
ligation of major veins, if necessary, is well tolerated in many instances. Survival depends on the number and magnitude of associated vascular and visceral
injuries. If an operation can be performed soon after injury, survival with most major abdominal arterial
injuries ranges from 35% to 85%. When major abdominal venous
injuries are considered, the survival rate ranges from 50% to 95%. Postoperative complications include
thrombosis of repairs, dehiscence of
suture lines, and
infection. Second-look operations may be beneficial to evaluate tenuous repairs, whereas various techniques are helpful in avoiding
suture line breakdowns as a result of
infection.