Scientific paper
Operative management and outcome of 302 abdominal vascular injuries

Presented at the 52nd Annual Meeting of the Southwestern Surgical Congress, Colorado Springs, Colorado, April 9–12, 2000.
https://doi.org/10.1016/S0002-9610(00)00519-5Get rights and content

Abstract

Background: Abdominal vascular injuries incur high mortality rates. The purposes of this study are (1) review institutional experience, (2) determine additive effect on mortality of multiple vessel injuries, (3) determine mortality of combined arterial and venous injuries, and (4) correlate mortality with American Association for the Surgery of Trauma–Organ Injury Scale (AAST-OIS) for abdominal vascular injury.

Methods: A retrospective 6-year study was made at an urban level I trauma center of patients with abdominal vascular injuries. Main outcome measure was survival.

Results: (1) There was a total of 302 patients, mean age 28, mean Injury Severity Score (ISS) 25 (range 4 to 75). Mechanism of injury was penetrating in 266 (88%), blunt in 36 (12%). Emergency Department thoracotomy was done in 43 of 302 (14%), 504 vessels were injured: arteries 238(47%), veins 266(53%). Surgical management was ligation 245, primary repair 141, prosthetic interposition grafts 24, autogenous 2. Overall mortality was 162 of 302 (54%). (2) Mortality multiple vessels injured: 1 vessel 160 (45%), 2 vessels 102 (60%), 3 vessels 33 (73%), >4 vessels 5 (100%). Mortality arterial injuries: aorta isolated (I) 78% versus combined with other arterial injuries (C) 82.4%, superior mesenteric artery (SMA) I 47.6% versus C 71.4%, iliac I 53% versus C 72.7%, renal I 37.5% versus C 66.7%. Venous injuries: inferior vena cava (IVC) isolated (I) 70% versus combined with other venous injuries (C) 77.7%, superior mesenteric vein (SMV) I 52.7% versus C 65%, IMV I 16% versus C 50%. (3) Specific mortality combined arterial and venous injuries: aorta plus IVC 93%, SMA plus SMV 43%, iliac artery plus vein 45.5%. (4) Mortality versus AAST-OIS: grade II 25%, grade III 32%, grade IV 65%, grade V 88%.

Conclusions: Abdominal vascular injuries are highly lethal. Multiple arterial and venous injuries increase mortality. Mortality correlates with AAST-OIS for abdominal vascular injury.

Section snippets

Methods

Over a 72-month period (January 1992 to December 1997) all patients admitted to the Los Angeles County–University of Southern California (LAC+USC) Medical Center, with a proven abdominal vascular injury were retrospectively reviewed and data entered into a collection sheet. Data collected included demographics, such as gender, age, mechanism of injury, admission vital signs, Revised Trauma Score (RTS), and Injury Severity Score (ISS). All abdominal vascular injuries were graded utilizing the

Results

Over the span of the 72-month study (January 1992 to December 1997) there were 302 patients admitted with abdominal vascular injuries. Their mean age was 28 (SD ± 11). The breakdown according to gender included a total of 276 males (91%) and 26 females (9%). There were 266 patients (88%) admitted with penetrating injuries: 216 (81%) sustained gunshot wounds, 46 (17%) sustained stab wounds, and 4 (2%) sustained shotgun wounds. Thirty-six (12%) were admitted with blunt trauma: 23 (64%) were

Comments

Abdominal vascular injuries are amongst the most lethal injuries encountered by modern day trauma surgeons. Many patients arrive with severe physiological compromise secondary to massive blood losses and great number of associated injuries.1, 2, 3, 4, 5, 6, 7 The incidence of abdominal vascular injury varies depending on the setting. During World War II, DeBakey and Simeone10 reported 49 abdominal vascular injuries in 2,471 patients for an incidence of 2%. Hughes11 reported seven iliac artery

Discussion

Dr. Kenneth L. Mattox (Houston, TX): It is altogether appropriate for centers with large volumes to attempt to push the therapeutic envelope, analyze their results and recommend appropriate changes to both themselves and to the world.

It is very clear that Dr. Asensio’s data supports the following three conclusions: One: The AAST-OIS injured grading documents that very sick patients have bad numbers. However, this review begs that the AAST-OIS be revised to upgrade entries to the Iliac artery,

Closing

Dr. Juan Asensio: There is, indeed, data from our institution that reported that patients brought in by EMS personnel did have higher mortality. That study, in which I did not participate, had a small number of these patients.

The vast majority of our patients were actually brought in by EMS. In reviewing the literature as well as our results, you’ll find that even though we have a 15-minute rule in L.A. County to transport these patients promptly to the operating room, one finds that actual

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