Prevalence and outcome of abdominal vascular injury in severe trauma patients based on a TraumaRegister DGU international registry analysis

This study details the etiology, frequency and effect of abdominal vascular injuries in patients after polytrauma based on a large registry of trauma patients. The impact of arterial, venous and mixed vascular injuries on patients’ outcome was of interest, as in particular the relevance of venous vessel injury may be underestimated and not adequately assessed in literature so far. All patients of TraumaRegister DGU with the following criteria were included: online documentation of european trauma centers, age 16–85 years, presence of abdominal vascular injury and Abbreviated Injury Scale (AIS) ≥ 3. Patients were divided in three groups of: arterial injury only, venous injury only, mixed arterial and venous injuries. Reporting in this study adheres to the STROBE criteria. A total of 2949 patients were included. All types of abdominal vessel injuries were more prevalent in patients with abdominal trauma followed by thoracic trauma. Rate of patients with shock upon admission were the same in patients with arterial injury alone (n = 606, 33%) and venous injury alone (n = 95, 32%). Venous trauma showed higher odds ratio for in-hospital mortality (OR: 1.48; 95% CI 1.10–1.98, p = 0.010). Abdominal arterial and venous injury in patients suffering from severe trauma were associated with a comparable rate of hemodynamic instability at the time of admission. 24 h as well as in-hospital mortality rate were similar in in patients with venous injury and arterial injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible subtle venous injury.

Prevalence and Outcome of Abdominal Vascular Injury in Severe Trauma Patients – An International Registry Analysis

BackgroundThis study details the etiology, frequency and effect of abdominal vascular injuries in patients after polytrauma.Patients and methodsAll patients of TraumaRegister DGU® with following criteria were included: online documentation of European trauma centers, age 16-85 years, presence of abdominal vascular injury, and AIS ≥ 3. Patients were divided in three groups of: arterial injury only, venous injury only, mixed arterial and venous injuries.ResultsA total of 2949 patients were included. All types of vessel injuries were more prevalent in patients with abdominal trauma followed by thoracic trauma. Rate of patients with shock upon admission were the same in patients with arterial injury alone (n= 606, 33%) and venous injury alone (n=95, 32%). Venous trauma showed higher odds ratio for in-hospital mortality (OR: 1.48; 95% CI 1.10-1.98, p=0.010).ConclusionAbdominal arterial injury and venous injury were equally responsible for the rate of hemodynamic instability at the time of admission. However, the proportion of adverse outcome during hospital stay was significantly higher in patients with venous injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible retroperitoneal hematoma caused by subtle venous injury.

Prevalence and Outcome of Abdominal Vascular Injury in Severe Trauma Patients – An International Registry Analysis

BackgroundAbdominal vascular injuries and the resulting hemorrhagic shock are still one of the main causes of death in trauma patients. This study details the etiology, frequency and effect of major vessel lesions of the abdomen in patients after polytrauma.Patients and methodsAll patients of TraumaRegister DGU® who met the following criteria were included: online documentation of European trauma centers, age 16-85 years, presence of abdominal vascular injury, and AIS ≥ 3. Patients were divided in three groups based on the type of vessel injuries: arterial injury only, venous injury only, mixed arterial and venous injuries.ResultsA total of 2949 patients met the inclusion criteria. A blunt mechanism of abdominal vascular injuries was more frequent in all three groups. All types of vessel injuries were more prevalent in patients with relevant abdominal trauma followed by relevant thoracic trauma. On admission to hospital the rate of patients with shock were the same in patients with arterial injury alone (n= 606, 33%) and venous injury alone (n=95, 32%). Patients with venous injury alone or together with arterial injuries had higher early (within first 24h) mortality rates (isolated arterial injury OR: 1.31; 95%, CI 1.14-1.50, p<0.001; isolated venous injury OR: 1.48; 95%, CI 1.10-1.98, p=0.010) and also in-hospital mortality.ConclusionAbdominal arterial injury and venous injury were equally responsible for the rate of hemodynamic instability at the time of admission. However, the proportion of adverse outcome during hospital stay was significantly higher in patients with venous injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible retroperitoneal hematoma caused by subtle venous injury.

Abdominal vascular injuries- what general/ trauma surgeons should know

Abdominal vascular injuries are the common cause of death after abdominal trauma. These are challenging injuries to manage due to severe haemodynamic instability, associated injuries and difficulty in accessing and controlling these vessels. Early control of bleeding can decrease the mortality in these patients. Abdominal vasculature is divided in four zones and each zone need different operative strategy for exposure. Principles of proximal and distal control are followed before exploring any haematoma. Endovascular interventions (angioembolization, stent-graft) have shown improved outcomes in patients with blunt abdominal trauma. Resuscitative Endovascular Balloon Occlusion of Aorta is minimal invasive method of achieving aortic occlusion and acts as bridge for definitive intervention or surgery. Updated knowledge is necessary for all those directly involved in managing these patients. The current review discusses relevant anatomy, principles, different surgical approaches and endovascular techniques to deal these injuries. Keywords: Abdominal trauma; injury; aorta; inferior vena cava. Continuous....