Management of upper abdominal vascular trauma

Abstract

Advances in the management of penetrating and blunt cardiovascular trauma have paralleled developments in the operative treatment of acquired vascular disease. Nevertheless, upper abdominal vascular trauma still presents a challenge to the surgeon in terms of control of hemorrhage, operative exposure, and multiple organ injury. Between January 1969 and December 1973, forty-six patients were seen with injuries to the upper abdominal aorta, vena cava, portal vein, or proximal few centimeters of the celiac axis or superior mesenteric arteries. Eighty-seven per cent of the patients presented in shock. Control of arterial hemorrhage was achieved by approaching the aorta from a posterolateral position after reflection of the viscera. Vena caval injuries were controlled by utilizing extensive liver mobilization as well as both transthoracic and transabdominal intracaval shunts. Dacron prostheses were employed successfully in the suprarenal position of both the aorta and vena cava. Through prompt resuscitative management, rapid assessment of intra-abdominal injuries, systematic approach to organ involvement, and adaptive exposure, control of upper abdominal vascular trauma was achieved with a reduced requirement for blood replacement and lower mortality. Adjunctive measures of intraoperative autotransfusion and microfiltration of homologous blood further improved survival in these patients with complex injuries.