Management of intra-abdominal vascular injury in trauma laparotomy: a South African experience

Weale, Ross; Kong, Victor; Manchev, V; Bekker, W; Oosthuizen, George; Brysiewicz, Petra; Laing, G L; Bruce, John; Clarke, Damian

doi:10.1503/cjs.009717

Cited by 10 publications

(11 citation statements)

References 20 publications

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“…Previous studies have demonstrated a direct correlation between the number of concomitant injuries, and mortality rates in patients with PAAI. 2,4,18,19 For example, Tybursky et al found a mortality rate of 64% in patients with an ISS ≥25 compared to 23% in patients with an ISS <25 after abdominal vascular injury. 19 In addition, they found a 100% mortality rate in patients with injury to 4 or more intra-abdominal blood vessels after penetrating injuries.…”

Section: Discussionmentioning

confidence: 99%

Penetrating Abdominal Aortic Injury: Comparison of ACS-Verified Level-I and II Trauma Centers

Sheehan

Grigorian

Maithel

et al. 2020

Vasc Endovascular Surg

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Objectives: Penetrating abdominal aortic injury (PAAI) is a highly acute injury requiring prompt surgical management. When compared to surgeons at level-II trauma centers, surgeons at level-I trauma centers are more likely to take in-house call, and may more often be available within 15 minutes of patient arrival. Thus, we hypothesized that level-I trauma centers would have a lower mortality rate than level-II trauma centers in patients with PAAI. Methods: We queried the Trauma Quality Improvement Program database for patients with PAAI, and compared patients treated at American College of Surgeons (ACS)-verified level-I centers to those treated at ACS level-II centers. Results: PAAI was identified in 292 patients treated at level-I centers and 86 patients treated at level-II centers. Patients treated at the 2 center types had similar median age, injury severity scores and prevalence of diabetes, hypertension, and smoking (p > 0.05). There was no difference in the frequency of additional intra-abdominal vascular injuries (p > 0.05). Median time to hemorrhage control (level-I: 40.8 vs level-II: 49.2 minutes, p = 0.21) was similar between hospitals at the 2 trauma center levels. We found no difference in the total hospital length of stay or post-operative complications (p > 0.05). When controlling for covariates, we found no difference in the risk of mortality between ACS verified level-I and level-II trauma centers (OR:1.01, CI:0.28-2.64, p = 0.99). Conclusion: Though the majority of PAAIs are treated at level-I trauma centers, we found no difference in the time to hemorrhage control, or the risk of mortality in those treated at level-I centers when compared to those treated at level-II trauma centers. This finding reinforces the ACS-verification process, which strives to achieve similar outcomes between level-I and level-II centers.

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Section: Discussionmentioning

confidence: 99%

Penetrating Abdominal Aortic Injury: Comparison of ACS-Verified Level-I and II Trauma Centers

Sheehan

Grigorian

Maithel

et al. 2020

Vasc Endovascular Surg

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“…In the grouped series analysis of selected civilian trauma, 4,890 injuries were identified in 3,599 patients 5 , 10 - 17 ). .…”

Section: Epidemiologymentioning

confidence: 99%

“…En el análisis agrupado de series seleccionadas de trauma civil se identificaron 4,890 lesiones en 3,599 pacientes 5 , 10 - 17 . Cuando se consideró el grupo de pacientes que requirieron tratamiento quirúrgico, las lesiones venosas sistémicas representaron el 48% de todas las lesiones, las del sistema porta el 11% y las arteriales el 41% ( Tabla 1 ).…”

Section: Epidemiologíaunclassified

Damage control in abdominal vascular trauma

et al. 2021

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Abdominal vascular trauma occurs in a small proportion of patients admitted in trauma centers. However, up to a quarter or a third of the patients who require a laparotomy will have a vascular injury. Preoperative identification is impossible in most cases, therefore, surgeons must be prepared for its early intraoperative recognition to allow appropriate management. This include temporary bleeding control techniques, identification of the probable injured vessel and the specific approach and management. Often, recognition of exsanguinating intra-abdominal hemorrhage will lead to immediate surgical indication, with activation of damage control protocols and consideration of early aortic occlusion.This paper illustrates the applications of damage control in the management of patients with abdominal vascular trauma.

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“…O trauma vascular representa um grande desafio para os profissionais da saúde, pois apresenta altas taxas de morbidade e de mortalidade, a qual pode chegar a 39%, principalmente devido a exsanguinação, que também causa coagulopatias (TALBOT et al, 2019;PRICHAYUDH et al, 2018;WEALE et al, 2018). Além disso, os traumas vasculares são raros e habitualmente estão associados a outras lesões, como traumatismo craniano, lesão de órgãos sólidos e/ou ocos, as quais podem tornar o tratamento mais desafiador (KOBAYASHI et al, 2020;KOBAYASHI et al, 2016).…”

Section: Definiçãounclassified

O diagnóstico e a conduta no trauma abdominal vascular / Diagnosis and management of abdominal vascular trauma

Velho¹,

Bonelly²,

Levy³

et al. 2021

BJDV

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Management of intra-abdominal vascular injury in trauma laparotomy: a South African experience

Cited by 10 publications

References 20 publications

Penetrating Abdominal Aortic Injury: Comparison of ACS-Verified Level-I and II Trauma Centers

Penetrating Abdominal Aortic Injury: Comparison of ACS-Verified Level-I and II Trauma Centers

Damage control in abdominal vascular trauma

O diagnóstico e a conduta no trauma abdominal vascular / Diagnosis and management of abdominal vascular trauma

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