Lesiones vasculares abdominales. El desafío del cirujano traumatológico

Introduction. Among all the injuries suffered by trauma patients, abdominal vascular injuries present the highest rates of mortality and morbidity. Methods. We performed a clinical review of the diagnosis, surgical approaches and treatment of patients with abdominal vascular injuries. The review was based on our experience of 302 patients presenting this type of injury. Results. Penetrating injuries accounted for 90-95% of all abdominal vascular injuries. Multiple organ injuries were frequent. Clinical signs of hemoperitoneum and/or peritonitis and the absence of femoral pulses were indications for laparotomy. In patients with cardio-pulmonary arrest, urgent thoracotomy with open cardiac massage and cross clamping of the aorta should be performed. The overall mortality rate was 54%, of which 85% was due to exsanguination. The main complications were compartment syndrome of the abdomen and limbs as well as a chronic cycle of acidosis, hypothermia and coagulopathies. Conclusions. Abdominal vascular injuries present high mortality and morbidity. Detailed knowledge of retroperitoneal anatomy and of the surgical approaches used to access the vessels, as well as appropriate clinical evaluation, will help to reduce mortality and complication rates in these patients.