Major Abdominal Vascular Trauma

Abstract

The increasing popularity of non-operative management for trauma patients is predicated on excellent imaging, the ability to percutaneously control bleeding and repair blood vessels, and the resources to closely monitor patients in a well-stocked intensive care unit. For example, whereas just a few years ago a patient with a gunshot wound to the flank that was hemodynamically stable would likely proceed directly to the operating room for an exploratory laparotomy, it is now acceptable to observe this patient if triple phase CT scan is normal. Unfortunately, this is not the situation in a combat setting. Although you may have a CT scanner, it may overheat; you may have a C-arm and feel comfortable performing endovascular procedures, but nobody else around you does; and you will have an ICU that is efficient but can easily be overwhelmed by a mass casualty event. It is therefore incumbent upon you and your operating team to be prepared to deal with whatever is brought to the ER, because if you are in a combat support hospital YOU are the highest level of care in country. The goal of this chapter is to assist you with major abdominal vascular trauma and pass on these lessons learned (often the hard way) from combat surgery.

Deployment Experience:

Niten Singh General Surgeon, 31st Combat Support Hospital, Balad, Iraq, 2003–2004

Vascular Surgeon, 28th Combat Support Hospital, Baghdad, Iraq, 2006–2007