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The major sites of hemorrhage in patients sustaining blunt or penetrating abdominal trauma are the viscera, the mesentery, and the major abdominal vessels. The term abdominal vascular injury generally refers to injury to major intraperitoneal or retroperitoneal vessels and is generally classified into four zones described as follows and in Table 34-1:

  • Zone 1: midline retroperitoneum
    • Supramesocolic region
    • Inframesocolic region
  • Zone 2: upper lateral retroperitoneum
  • Zone 3: pelvic retroperitoneum
  • Porta hepatis/retrohepatic inferior vena cava

Table 34-1 Classification of Abdominal Vascular Injury

As many of these vessels are somewhat difficult to quickly access via a midline laparotomy incision, a systematic operative approach is required to adequately diagnose and manage these potentially devastating injuries. A general discussion of epidemiology and methods of diagnosis, with subsequent descriptions of the operative management of abdominal vascular injuries within each region of the abdomen, follows.

In reviews of vascular injuries sustained in military conflicts, abdominal vascular injuries have been extraordinarily rare. For example, DeBakey and Simeone’s classic article on 2,471 arterial injuries during World War II included only 49 that occurred in the abdomen, an incidence of 2%.1 Reporting on 304 arterial injuries from the Korean conflict, Hughes noted that only 7, or 2.3%, occurred in the iliac arteries.2 In the review by Rich et al. of 1,000 arterial injuries in the Vietnam War, only 29, or 2.9%, involved abdominal vessels.3 Finally, a recent review of abdominal injuries during the Iraqi conflict documented only 4 injuries to major vessels in 145 patients undergoing laparotomy (2.8%).4

The data from civilian trauma centers are quite different. In 1979, 15% of patients with abdominal trauma treated at the Ben Taub General Hospital in Houston had injuries to major vascular structures.5 Also, abdominal vascular injury accounted for 27.5% of all arterial injuries treated over that same time period. A similar review from the same hospital in 1982 revealed that 31.9% of all vascular injuries occurred in the abdomen, including 18.5% of all arterial injuries and 47.5% of all venous injuries.6 Finally, a ...

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