Vascular Injuries in the Abdomen

Trauma to the Superior Mesenteric Artery and Superior Mesenteric Vein: A Narrative Review of Rare but Lethal Injuries

“…According to previous studies, penetrating injuries, most commonly gunshot (GSW) or stab wounds (SW), represent roughly 80–95% of visceral vascular injuries [20]. Blunt injuries account for 5–20% and are commonly due to motor vehicle collisions, falls, or unusual accidents [2, 8, 15, 20].…”

“…Presentation of SMA injury ranges widely, from massive intra‐abdominal hemorrhage to bowel ischemia secondary to thrombosis of the vessel [20]. Oftentimes, patients with abdominal vascular injuries arrive at the hospital in profound shock secondary to hemorrhage and may have already developed the lethal triad of acidosis, hypothermia, and coagulopathy [5].…”

“…In primary repair studies by Lucas [3], two of the three SMA injuries treated with re‐anastomosis developed subsequent thrombosis, raising the concern that primary re‐anastomosis could be associated with a high failure rate [3, 21]. Autogenous grafts using the saphenous vein, femoral vein, or synthetic (PTFE) grafts are options for definitive repair [20, 30]. Autogenous material is preferable due to the risk of synthetic graft infection if there is simultaneous GI spillage due to coexisting intestinal injuries [20, 30].…”

“…Autogenous grafts using the saphenous vein, femoral vein, or synthetic (PTFE) grafts are options for definitive repair [20, 30]. Autogenous material is preferable due to the risk of synthetic graft infection if there is simultaneous GI spillage due to coexisting intestinal injuries [20, 30].…”

“…In general, it is best to repair all SMA injuries with exception of those in the most distal branches [2, 3, 8, 15, 18]. SMA ligation places the patient at high risk for significant bowel ischemia from the ligament of Treitz to the right colon and can lead to extensive bowel necrosis, acidosis, and coagulopathy [15, 20, 30, 43]. In a study of 250 SMA injuries, 72% were managed with ligation, indicating that while not ideal, ligation may be the predominant technique employed in the management in SMA injury [2].…”