Abdominal Vascular Hemorrhage: More than Just Clamp and Sew
Injuries to major abdominal vessels are among the most lethal in all of trauma surgery. Patients are hemodynamically unstable upon arrival, the vessels are large, many named arteries and veins are adjacent to one another, moderate to extensive dissection is required to expose some, there are always associated intra-abdominal injuries, and there are sequelae when arterial repairs are delayed and/or when venous ligation is performed.
A successful repair, shunting, or ligation that saves the patient’s life depends on many factors. These include the surgeon’s technical skills; recognition of the different approaches to tamponaded hematomas versus active hemorrhage; knowledge of different options for arterial repair, especially when gastrointestinal contamination is present; and appropriate management of the aforementioned sequelae of ligation of major veins.
Depending on the patient’s hemodynamic status on admission, the presentation of hematoma versus hemorrhage, and which vessels are injured, survival rates for these potentially lethal injuries are very reasonable in the modern era.