Abdominal Vascular Injuries Research Articles

Abdominal Arterial Translation in Lower Lumbar Spine Level Due to Positional Change: A Clinical Survey Using Intraoperative Computed Tomography.

Background: Abdominal vascular injury, a fatal complication of lumbar disc surgery, should concern spine surgeons. This study aimed to compare the position of the abdominal arteries in the supine and prone positions and the factors involved. Thirty patients who underwent lumbar surgery by posterior approach were included. Methods: All patients underwent computed tomography (CT) preoperatively in the supine position and intraoperatively in the prone position. In the CT axial image, at the L4, L4/5 disc, L5, and L5/S1 disc level, we measured the shortest distance between the abdominal arteries and the vertebral body (SDA: shortest distance to the aorta), and the amount of abdominal arterial translation, defined as "SDA on intraoperative CT" minus "SDA on preoperative CT". Additionally, the preoperative CT axial images were evaluated for the presence of aortic calcification. Results: No significant difference in SDA values based on patients' positions was observed at each level. In males, the supine position brought the abdominal artery significantly closer to the spine at the left side of the L5/S level (p = 0.037), and, in cases of calcification of the abdominal artery, the abdominal artery was found to be closer to the spine at the left side of the L4/5 level (p = 0.026). Conclusions: It is important to confirm preoperative images correctly to prevent great vessel injuries in lumbar spine surgery using a posterior approach.

The cost of gunshot abdominal vascular injuries: Its impact on patient, family, and hospital

The cost of gunshot abdominal vascular injuries: Its impact on patient, family, and hospital

Evaluation of Outcomes and Treatment Options Among Trauma Patients with Abdominal Vascular Injuries.

Abdominal vascular injuries are associated with significant morbidity and mortality. Treatment options include non-operative management, open repair, and endovascular procedures. This study aimed to characterize patients and detail treatment modalities among those who sustained a traumatic abdominal vascular injury. A six-year descriptive retrospective study was conducted at a level 1 trauma center and included all adult patients who sustained an abdominal vascular injury. Data abstracted included demographics, admitting characteristics, mechanism of injury, admitting vitals, injury details, diagnostic and treatment information, hospital course, and follow-up data. Fifty-seven patients were admitted with abdominal vascular injuries, however, 14 patients sustained injuries to smaller vascular branches and were excluded. Most vascular injuries involved the iliac artery (27.9%, n = 12), abdominal aorta (25.6%, n = 11), and inferior vena cava (25.6%, n = 11). Twenty-seven percent (n = 12) of patients sustained an injury to more than one vascular structure. Thirty-four percent of patients (n = 15) died before treatment of the abdominal vascular injury. Among the 28 patients (65.1%) treated for their vascular injuries, 46.4% (n = 13) were treated with open surgery, 32.1% (n = 9) were treated non-operatively, and 21.4% (n = 6) with coil embolization. Sixty-four percent of the patients (n = 18) who survived to discharge presented for follow-up care with a mean follow-up period of 3 ± 4.1 months. There were no vascular reinterventions after discharge for patients who followed up with our hospital. Study findings suggested that appropriately selected cases of traumatic vascular injuries may be managed non-operatively and safely, as there were no mortalities, complications, or reinterventions among these patients.

Spectrum of paediatric blunt abdominal trauma in a tertiary care hospital in India.

To study the profile of paediatric blunt abdominal trauma and to assess the correlation of grade of injury with the outcome. It is a prospective observational study from January 2015 to December 2020. Children below 12 years with blunt abdominal trauma were included. Patient demographic data, treatment given and the final outcome were recorded. All patients were followed up for a minimum of 6 months to maximum 5 years. A total of 68 patients were included in the study. Fall from height was the most common mode of injury (62%) followed by road traffic accidents (35%) and the other causes included in the miscellaneous group (hit by animal and fall of heavy object on the abdomen; 3%). Most commonly injured organ was liver (n = 28, 41%) followed by spleen (n = 18, 26%) and kidney (n = 15, 22%). Other injuries were bowel perforations (jejunal [n = 4], ileal [n = 1] and large bowel [n = 1]; 9%), pancreaticoduodenal (n = 5, 7%), urinary bladder (n = 3, 4%), abdominal vascular injury (iliac vein-1, inferior vena cava-1;3%), adrenal haematoma (n = 2,3%) and common bile duct (CBD) injury (n = 1, 1%). More than one organ injury was seen in 13 cases (19%). Non-operative management was successful in 84% (n = 27) and laparotomy was done in 16% (n = 11). Most of the patients sustained Grade IV injury (n = 36, 53%) and majority of the patients (n = 60, 88%) had good outcome without any long-term complications. Profile of paediatric blunt abdominal trauma include solid organ injuries such as liver, spleen, kidney, pancreas, adrenal gland and others like bowel injury, CBD, urinary bladder and abdominal vascular injury. The grade of injury does not correlate with the outcome in a higher grade of injury and these children had good outcome.

Repair by Primary Closure of Traumatic Blunt Duodenal Injuries: Simple is Not Always Safe

IntroductionRecent literature on managing traumatic duodenal injuries suggests the superiority of primary repair. We hypothesized that duodenal trauma repair by primary closure might not be a safe strategy in an environment dealing predominantly blunt injuries with limited resources. MethodsData analysis was done from the prospectively maintained trauma registry. The study period chosen was from January 1, 2014 to December 31, 2018. Data of 63 patients were analyzed for demographics, injuries, management, and outcome. Logistic regression was used to identify mortality predictors. ResultsThe most common mechanism of injury was blunt (56/63, 88.9%). Forty (63.5%) patients had associated intraabdominal injuries. The most common American Association for the Surgery of Trauma grade of injury to the duodenum was three in 21 patients. Univariate analysis showed that mortality was associated with hypotension on presentation, higher duodenal grade, associated abdominal vascular injuries, primary closure, and duodenal leak. Logistic regression showed associated associated abdominal vascular injuries, primary closure, and leak remained significant predictors of mortality. ConclusionsPrimary repair was found to be an independent predictor of mortality. A patient's physiology is a critical determinant of the outcome. Liberal use of tube duodenostomy over primary repair seems reasonable for blunt duodenal injury management.

Single-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle for incarcerated ovarian hernia in infants

BackgroundThe purpose of this study was to evaluate the safety and efficacy of single-site laparoscopic extraperitoneal hernia sac ligation with an epidural needle for incarcerated ovarian hernias in infants and young children.MethodsThe clinical data of 38 infants with incarcerated ovarian hernias who underwent single-site laparoscopic extradural needle extraperitoneal hernia sac ligation from January 2015 to January 2018 were retrospectively analysed.ResultsAll procedures were successfully performed using laparoscopy with no need for conversion to open surgery. The time of hospital stay was 1.30 ± 0.39 days. During hospitalization and follow-up, there were no complications, such as intestinal or bladder injury, abdominal wall vascular injury, ovarian atrophy, hernia recurrence or contralateral indirect hernia. However, three patients experienced complications, including two cases of poor healing of the umbilical incision and one case of suture granuloma.ConclusionsSingle-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle is a safe and feasible method for the treatment of incarcerated ovarian hernias in infants and young children. It has the advantages of minimal trauma, no scarring and good cosmetic effects.

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.

Venous Chimney Procedure: A Novel Technical Solution to Prevent Iatrogenic Budd– Chiari Syndrome Following Retrohepatic Vena Cava Injury

Traumatic inferior vena cava (IVC) lesions account for approximately 25% of abdominal vascular injuries and are among the most challenging and lethal lesions sustained by trauma patients. Whether caused by blunt or penetrating mechanisms of injury, the overall mortality rate is up to 92%; as many as 50% of the patients with those injuries die before reaching medical care, and the mortality rate among patients who arrive to a trauma center, with signs of life and/or receive operative treatment, ranges between 20% and 57% (1).
 Retrohepatic Vena Cava (RHVC) injuries (RHVCI) are extremely rare and as such both the treating trauma surgeon, as well as the vascular surgeon, lacks the necessary experience to deal with such complicated injuries. The mortality rates secondary to these injuries are extremely high, even with damage control management concepts application. Improving the outcome of these injuries remains a significant challenge of modern trauma care (2, 3).
 The treatment of RHVCI confronts the treating surgeon, with major obstacles, which raises from the anatomic location of the RHVC at the posterior aspect of the liver and the abundancy of bridging veins between the RHVC and the liver. These anatomic obstacles creates a major technical challenge of gaining proximal and distal control, in proximity to the injured RHVC. This many times necessitates abdominal as well as thoracic exposure in order to gain proper control.
 The average trauma, as well as the vascular, surgeons are not familiar with handling such complex injuries. This is even truer as referred to the new generation of vascular surgeons, whose experience with open vascular surgery, mainly in such extreme situations, decreases with the increasing usage of endovascular techniques (4). 
 The advancements in endovascular techniques have introduced new alternatives to traditional open repair strategies. In many cases, RHVCI treatment requires exploration of a retro-hepatic hematoma, which might be the single thing that prevents free venous rupture and as such, it should be avoided. Venous balloon occlusion is a novel endovascular strategy that may be particularly advantageous in those circumstances as a bridging maneuver, for proximal and distal control, during hybrid repair. Our case in unique since it highlights the option of total endovascular treatment, using arterial treatment concepts, to treat this extremely challenging injury. 

Venous Chimney Procedure: A Novel Technical Solution to Prevent Iatrogenic Budd– Chiari Syndrome Following Retrohepatic Vena Cava Injury

Traumatic inferior vena cava (IVC) lesions account for approximately 25% of abdominal vascular injuries and are among the most challenging and lethal lesions sustained by trauma patients. Whether caused by blunt or penetrating mechanisms of injury, the overall mortality rate is up to 92%; as many as 50% of the patients with those injuries die before reaching medical care, and the mortality rate among patients who arrive to a trauma center, with signs of life and/or receive operative treatment, ranges between 20% and 57% (1).
 Retrohepatic Vena Cava (RHVC) injuries (RHVCI) are extremely rare and as such both the treating trauma surgeon, as well as the vascular surgeon, lacks the necessary experience to deal with such complicated injuries. The mortality rates secondary to these injuries are extremely high, even with damage control management concepts application. Improving the outcome of these injuries remains a significant challenge of modern trauma care (2, 3).
 The treatment of RHVCI confronts the treating surgeon, with major obstacles, which raises from the anatomic location of the RHVC at the posterior aspect of the liver and the abundancy of bridging veins between the RHVC and the liver. These anatomic obstacles creates a major technical challenge of gaining proximal and distal control, in proximity to the injured RHVC. This many times necessitates abdominal as well as thoracic exposure in order to gain proper control.
 The average trauma, as well as the vascular, surgeons are not familiar with handling such complex injuries. This is even truer as referred to the new generation of vascular surgeons, whose experience with open vascular surgery, mainly in such extreme situations, decreases with the increasing usage of endovascular techniques (4). 
 The advancements in endovascular techniques have introduced new alternatives to traditional open repair strategies. In many cases, RHVCI treatment requires exploration of a retro-hepatic hematoma, which might be the single thing that prevents free venous rupture and as such, it should be avoided. Venous balloon occlusion is a novel endovascular strategy that may be particularly advantageous in those circumstances as a bridging maneuver, for proximal and distal control, during hybrid repair. Our case in unique since it highlights the option of total endovascular treatment, using arterial treatment concepts, to treat this extremely challenging injury. 

Features of surgical tactics for injuries of abdominal and retroperitoneal major arteries (review of literature)

Injuries of abdominal and retroperitoneal major blood vessels are the most severe injuries. Delayed diagnosis, irrational accesses and methods of temporary hemostasis aggravate the severity of the condition and lead to life-threatening complications. The objective was to summarize the data from Russian and foreign literature for improving the results of treatment of patients with injury of abdominal and retroperitoneal major vessels. The article discusses the etiology, clinic, diagnostic algorithm for abdominal vascular injury and treatment of patients with injury of abdominal arteries, describes the methods of temporary and final hemostasis. It is necessary for a general surgeon to know the therapeutic and diagnostic algorithm for vascular injury, rational accesses to them and methods of temporary and final hemostasis, as well as the principles of «damage control» tactics to save the life of the patient.

Suprarenal Inferior Vena Cava Ligation

Inferior vena cava (IVC) injuries account for about 25%–40% of abdominal vascular injuries. Blunt vena cava injury has a lower survival rate than penetrating injury. They may present with torrential bleed. In extreme cases, ligation of the IVC may have to be done as a damage control procedure. However, it is associated with significant morbidity and mortality, especially when the suprarenal IVC is ligated. It can lead to acute kidney injury and lower limb compartment syndrome. Suprarenal IVC ligation has been done in oncological resections, as it is a chronic disease that allows collateral vessel formation. However, there is a paucity of data on the ligation of the suprarenal IVC in acute trauma. We present a case of penetrating injury to the IVC which was managed initially by suprarenal IVC ligation, followed by synthetic interposition graft placement once the patient stabilized hemodynamically. The case highlights that this approach can be viable as a damage control procedure in exsanguinating patients.

Abdominal vascular injuries- what general/ trauma surgeons should know

Abstract 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....

Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review

BackgroundAlthough damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes).MethodsWe searched 11 databases (1950–April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions.ResultsAmong 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) volume exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring > 10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications.ConclusionsFew indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.

Risk factors for abdominal surgical site infection after exploratory laparotomy among combat casualties.

Surgical site infections (SSIs) are well-recognized complications after exploratory laparotomy for abdominal trauma; however, little is known about SSI development after exploration for battlefield abdominal trauma. We examined SSI risk factors after exploratory laparotomy among combat casualties. Military personnel with combat injuries sustained in Iraq and Afghanistan (June 2009 to May 2014) who underwent laparotomy and were evacuated to participating US military hospitals were included. Log-binominal regression was used to identify SSI risk factors. Of 4,304 combat casualties, 341 patients underwent a total of 1,053 laparotomies. Abdominal SSIs were diagnosed in 49 patients (14.4%): 8% with organ space SSI, 4% with deep incisional SSI, and 4% with superficial SSIs (4 patients had multiple SSIs). Patients with SSIs had more colorectal (p < 0.001), small bowel (p = 0.010), duodenum (p = 0.006), pancreas (p = 0.032), and abdominal vascular injuries (p = 0.040), as well as prolonged open abdomen (p = 0.004) and more infections diagnosed before the SSI (or final exploratory laparotomy) versus non-SSI patients (p < 0.001). Sustaining colorectal injuries (risk ratio [RR], 3.20; 95% confidence interval [CI], 1.58-6.45), duodenum injuries (RR, 6.71; 95% CI, 1.73-25.58), and being diagnosed with prior infections (RR, 10.34; 95% CI, 5.05-21.10) were independently associated with any SSI development. For either organ space or deep incisional SSIs, non-intra-abdominal infections, fecal diversion, and duodenum injuries were independently associated, while being injured via an improvised explosive device was associated with reduced likelihood compared with penetrating nonblast (e.g., gunshot wounds) injuries. Non-intra-abdominal infections and hypotension were independently associated with organ space SSIs development alone, while sustaining blast injuries were associated with reduced likelihood. Despite severity of injuries and the battlefield environment, the combat casualty laparotomy SSI rate is relatively low at 14%, with similar risk factors and rates reported following severe civilian trauma. Epidemiological, level III.

Incidence of Vascular Injuries in poly-traumatized Patients

Background: Vascular injury resulting from trauma is a leading cause of morbidity and mortality worldwide. Exsanguination is perhaps the most important cause of potentially preventable death after injury. The resulting ischemic tissue damage leads to high rates of amputation in a characteristically young and active population. Objective: To determine the incidence of vascular injuries, modes and mechanisms of trauma and their relations with regional vascular injury distribution and the outcome of vascular injuries in polytrauma patients. Patients and methods: This is a prospective observational analytical (cohort) study that included 520 patients who were presented by multiple causes of trauma to Mansoura University Emergency Hospital, Mansoura, Egypt. A level 1-trauma center with about 250,000 visits and 25000 trauma cases admission per year. This study was conducted over the period of 1 year from January 2019 to December 2019. Results: According to abbreviated injury scale (AIS) ≥3, patients with vascular injuries had considerable more severe injuries than other patients. The most common regions with vascular injuries were peripheral vascular injuries in 95.8% [52.6% in lower limb and 43.2% in upper limb], followed by central vascular injuries in 4.2% [1.6% in neck, 1.6% in thorax and 1 % in abdomen]. Blunt trauma was considerably more common than penetrating trauma in both groups. Moreover, blunt trauma was more common in all regional vascular injuries (66.7% of neck, 75% of lower limb, and 100% of thoracic and abdominal vascular injuries) except upper limb (in 47.8%). Conclusion: The vascular trauma is associated with more injury severity AIS, injury severity score (ISS) and higher mortality rate than other polytrauma patients.

Incidence of Vascular Injuries in poly-traumatized Patients

Background: Vascular injury resulting from trauma is a leading cause of morbidity and mortality worldwide. Exsanguination is perhaps the most important cause of potentially preventable death after injury. The resulting ischemic tissue damage leads to high rates of amputation in a characteristically young and active population. Objective: To determine the incidence of vascular injuries, modes and mechanisms of trauma and their relations with regional vascular injury distribution and the outcome of vascular injuries in polytrauma patients. Patients and methods: This is a prospective observational analytical (cohort) study that included 520 patients who were presented by multiple causes of trauma to Mansoura University Emergency Hospital, Mansoura, Egypt. A level 1-trauma center with about 250,000 visits and 25000 trauma cases admission per year. This study was conducted over the period of 1 year from January 2019 to December 2019. Results: According to abbreviated injury scale (AIS) ≥3, patients with vascular injuries had considerable more severe injuries than other patients. The most common regions with vascular injuries were peripheral vascular injuries in 95.8% [52.6% in lower limb and 43.2% in upper limb], followed by central vascular injuries in 4.2% [1.6% in neck, 1.6% in thorax and 1 % in abdomen]. Blunt trauma was considerably more common than penetrating trauma in both groups. Moreover, blunt trauma was more common in all regional vascular injuries (66.7% of neck, 75% of lower limb, and 100% of thoracic and abdominal vascular injuries) except upper limb (in 47.8%). Conclusion: The vascular trauma is associated with more injury severity AIS, injury severity score (ISS) and higher mortality rate than other polytrauma patients.

Near-transection of abdominal aorta due to stab injury: a case report

Abdominal vascular injuries are amongst the most lethal injuries encountered by modern day trauma and vascular surgeons. Penetrating injuries to aorta have a wide spectrum of presentation mortality being 50-70%. 38-year-old male presented to emergency department with stab injury to abdomen with a knife stuck in-situ. Patient was conscious with herniating bowel loops from stab site. Bilateral limbs had good pulsations and no neurological deficit. Patient was taken for emergency laparotomy and found to have complete jejunal transection with near transection of aorta with knife stuck in the vertebra. Primary repair of aorta was done with prolene 5-0 along with jejuno-jejunal anastomosis. Patient was transfused with 12 units of blood and 8 units of FFP. Postoperatively patient recovered well and was discharged on post-operative day (POD) 14 with good recovery and follow up was uneventful. Spectrum of penetrating aortic injuries varies from stable patients to severely exsanguinated in vicious cycle of shock, acidosis, coagulopathy and arrhythmias causing high mortality and morbidity. Our case had contained retroperitoneal hematoma with stable vitals and good general condition and due to early diagnosis and timely institution of surgery the patient survived and recovered uneventfully. All abdominal stab injuries are to be taken as having vascular injuries. Surgery has to be taken up as an integral part of resuscitation with quickest and most effective diagnostics along with lifesaving procedures to have lesser morbidity and mortality.

More medications, more problems: results from the Sedation Level after Emergent Exlap with Packing for TRAUMA (SLEEP-TRAUMA) study.

PurposeSedation management of trauma patients after damage control laparotomy (DCL) has not been optimized. We evaluated if shorter sedation exposure was associated with increased proportion of delirium-free/coma-free (DF/CF-ICU) days and change in time to definitive fascial closure (DFC).MethodsWe reviewed trauma DCL patients at an ACS-verified level I center over 5 years as shorter (SE) or longer than median (LE) sedation exposure. We compared demographics, injury patterns, hemodynamic parameters, and injury severity between groups. We calculated the propensity for each patient to achieve DFC using age, gender, ISS, red blood cell transfusion, bowel discontinuity, abdominal vascular injury, and time to first takeback; we then determined the effect of sedation exposure on rate of DFC by multivariate Cox regression, adjusted for propensity to achieve DFC. We used linear regression adjusted for age, ISS, head-AIS, bowel discontinuity, and vascular injury to determine the effect of sedation exposure on the proportion of DF/CF-ICU days.Results65 patients (33.8% penetrating) had mean age 41.8 ± 16.0, ISS 27.1 ± 14.2, Head-AIS 1.2 ± 1.6 and median sedation exposure of 2.2 [IQR 0.78, 7.3] days (35 SE and 30 LE). Pattern and severity of solid organ injuries and proportion of small and large bowel and vascular injuries were similar between groups. LE had more abdominal sepsis (23.3% vs 0%, p = 0.003) and enterocutaneous fistula (16.7% vs 0%, p = 0.016), and more ventilator (17.3 ± 12.7 vs 6.1 ± 6.8, p < 0.001), ICU (20.8 ± 14.2 vs 7.2 ± 7.6, p < 0.001), and hospital days (29.6 ± 19.6 vs 13.9 ± 9.0, p < 0.001). DFC was achieved more rapidly in the SE group (2.0 ± 1.5 days vs 3.9 ± 3.7 days [unadjusted], p = 0.023) and SE had a higher proportion of unadjusted DF/CF-ICU days (33.0 ± 32.0% vs 18.1 ± 16.4%, p = 0.020).SE was associated with an increased proportion of adjusted DF/CF-ICU days by multivariate linear regression (13.1% [95% CI 1.4–24.8%], p = 0.029) and with faster adjusted rate of DFC by multivariate Cox regression (RR 2.28 [95% CI 1.25–4.15, p = 0.007]).ConclusionsShorter sedation exposure is associated with increased proportion of DF/CF-ICU days and more rapid DFC after DCL for trauma.Electronic supplementary materialThe online version of this article (10.1007/s00068-020-01524-9) contains supplementary material, which is available to authorized users.

American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of abdominal vascular injuries.

Abdominal vascular trauma accounts for a small percentage of military and a moderate percentage of civilian trauma, affecting all age ranges and impacting young adult men most frequently. Penetrating causes are more frequent than blunt in adults, while blunt mechanisms are more common among pediatric populations. High rates of associated injuries, bleeding, and hemorrhagic shock ensure that, despite advances in both diagnostic and therapeutic technologies, immediate open surgical repair remains the mainstay of treatment for traumatic abdominal vascular injuries. Because of their devastating nature, abdominal vascular injuries remain a significant source of morbidity and mortality among trauma patients. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seek to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of abdominal vascular injuries. LEVEL OF EVIDENCE: Review study, level IV.

The cost of gunshot abdominal vascular injuries. Its impact on patient, family and hospital.

Violent trauma with penetrating injuries is a relevant public health issue. Penetrating abdominal wounds cause 90-95% of vascular injuries, which not only have high associated morbidity and lethality, but also involve high attention costs. Cost analysis in hospitals has become a topic of great interest, as it justifies changes in hospital organization and management. Determine the cost of gunshot abdominal vascular injuries for the patient, his family and the hospital. We drove an observational, descriptive, prospective and longitudinal study of patients with of gunshot abdominal vascular injuries admitted in the Mexican Red Cross Trauma Center in the Federal District from January 1st to October 31st, 2018. 8149 patients were admitted in the emergency department, 149 with a diagnosis of gunshot injury, of which 6 (0.07%) had abdominal vascular injury. The total cost of medical care these patients was on average $174,770.79 (median $132,999.50) per capita, amount that surpasses their annual income and implies an institutional absorption of expenditure up to 95.5%. Institutional investment on the attention of high-impact pathologies and the development of strategies that facilitate access to health services are a real and priority necessity.