TY  - CHAP
M1  - Book, Section
TI  - Abdominal Vessels
A1  - Feliciano, David V.
A1  - Asensio, Juan A.
A2  - Feliciano, David V.
A2  - Mattox, Kenneth L.
A2  - Moore, Ernest E.
PY  - 2020
T2  - Trauma, 9e
AB  - KEY  POINTSPatients  with  gunshot  wounds  to  the  abdomen  will  have  injury  to  a  named  abdominal  vessel  20%  to  25%  of  the  time.Abdominal  vessel  injuries  will  present  with  intraperitoneal  hemorrhage;  a  contained  mesenteric,  retroperitoneal,  or  portal  hematoma;  thrombosis;  or  some  combination  of  these.Options  for  management  of  abdominal  vessel  injuries  include  nonoperative  (intimal  flap  on  computed  tomography  angiogram),  endovascular  (hostile  abdomen,  delayed  diagnosis,  or  failed  prior  repair),  and  operative.A  midline  supramesocolic  hematoma  is  approached  with  a  left-sided  medial  mobilization  maneuver,  whereas  hemorrhage  is  approached  directly  through  the  lesser  sac  to  the  diaphragmatic  aorta.The  proximal  superior  mesenteric  artery  and  common  and  external  iliac  arteries  should  always  be  shunted  and  never  ligated  during  damage  control  operations.Ligation  of  the  infrarenal  inferior  vena  cava  after  a  severe  injury  is  more  commonly  practiced  in  the  modern  era  and  is  usually  well  tolerated  in  young  patients.Endovascular  stents  or  stent  grafts  are  commonly  placed  to  cover  intimal  defects  or  restore  arterial  flow  after  blunt  injury  of  the  renal  artery.An  end-to-end  anastomosis  or  interposition  graft  in  the  common  or  external  iliac  artery  in  the  presence  of  significant  enteric  or  colonic  contamination  has  an  increased  rate  of  postoperative  infection  and  subsequent  arterial  blowout.Survival  rates  after  abdominal  arterial  injuries  are  as  follows:  suprarenal  aorta,  8%  to  24%;  infrarenal  aorta,  34%  to  58%;  superior  mesenteric  artery,  40%  to  61%;  and  iliac  artery,  60%  to  80%.Survival  rates  after  abdominal  venous  injuries  are  as  follows:  infrarenal  inferior  vena  cava,  46%  to  76%;  superior  mesenteric  vein,  35%  to  71%;  iliac  vein,  74%  to  91%;  and  portal  vein,  50%.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/18
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1175138840
ER  -