Abstract
The evaluation and management of patients with abdominal vascular trauma or injury requires immediate and effective decision-making in these unfavorable circumstances. The majority of these patients arrive at trauma centers in profound shock, secondary to massive blood loss, which is often unrelenting. Moreover, ischemia, compartment syndrome, thrombosis, and embolization may also be life threatening and require immediate intervention. To minimize the risk of these potentially lethal complications, early understanding of the disease process and emergent therapeutic intervention are necessary. In the literature, the management of acute traumatic vascular injuries is restricted to traditional open surgical techniques. However, in penetrating injuries surgeons often face a potentially contaminated field, which renders the placement of prosthetic grafts inappropriate. Currently, however, there are sparse data on the management of vascular trauma with endovascular techniques. The role of endovascular technique in penetrating abdominal vascular trauma, which is almost always associated with severe active bleeding, is limited. It is worth mentioning that hybrid operating rooms with angiographic radiology capabilities offer more opportunities for the management of this kind of injuries by either temporary control of the devastating bleeding using endovascular balloon tamponade or with embolization and stenting. On the other hand, blunt abdominal injuries are less dangerous and they could be treated at most times by endovascular means. Since surgeons continue to encounter abdominal vascular trauma, open and endovascular techniques will evolve constantly giving us encouraging messages for the near future.
Highlights
The evaluation and management of patients with abdominal vascular trauma or injury requires rapid and effective decision-making in these unfavorable circumstances
We summarize all the available data on abdominal vascular trauma after the introduction of endovascular surgery in the treatment armamentarium, in order to provide surgeons and other physicians with a succinct and focused update
This zone is subdivided into the supramesocolic [suprarenal aorta, celiac axis (CA), superior mesenteric artery (SMA), renal arteries (RAs), the supramesocolic area of inferior vena cava (IVC), superior mesenteric vein (SMV)] area and the inframesocolic area that contains the infrarenal aorta and the IVC
Summary
First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece, 2 Department of Surgery, Duke University Hospital, Durham, NC, United States. Edited by: Efthymios Avgerinos, University of Pittsburgh Medical Center, United States. National and Kapodistrian University of Athens, Greece. Specialty section: This article was submitted to Vascular Surgery, a section of the journal
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