RT Book, Section
A1 Bolin, Jeremy
A1 Galante, Joseph
A1 Humphries, Misty D.
A2 DuBose, Joseph J.
A2 Teixeira, Pedro G.
A2 Rajani, Ravi R.
SR Print(0)
ID 1200600007
T1 Major Truncal Venous Injuries
T2 Vascular Injury: Endovascular and Open Surgical Management
YR 2023
FD 2023
PB McGraw Hill
PP New York, NY
SN 9781264269822
LK accesssurgery.mhmedical.com/content.aspx?aid=1200600007
RD 2024/04/16
AB Major  truncal  venous  structures  include  the  inferior  vena  cava  (IVC),  the  portal  venous  system  (i.e.,  the  portal  vein,  the  superior  mesenteric  vein  [SMV],  the  splenic  vein,  and  the  inferior  mesenteric  vein),  the  hepatic  veins,  the  iliac  veins,  and  the  renal  veins.  Renal  venous  injuries  are  addressed  in  Chapter  13,  “Mesenteric  and  Renal  Artery  Injuries”  and  are  not  discussed  in  this  chapter.  The  portal  venous  system  and  hepatic  venous  vein  tributaries  are  located  within  the  peritoneal  cavity.  As  such,  injuries  to  these  structures  manifest  as  bleeding  within  the  peritoneum.  The  remaining  major  truncal  venous  structures  are  within  the  retroperitoneum.  Injuries  to  the  major  truncal  venous  injuries  traditionally  encompass  four  zones  in  the  retroperitoneum  that  have  been  used  for  trauma  and  that  can  be  from  penetrating  or  blunt  trauma  (Fig.  16-1).  These  zones  are  divided  into  Zone  1  (IVC  and  abdominal  aorta),  Zone  2  (renal  veins  and  arteries),  Zone  3  (pelvis  with  iliac  vasculature),  and  Zone  4  (retrohepatic  IVC  and  hepatic  veins).  Note:  Zone  4  is  not  shown  in  Fig.  16-1  but  lies  within  the  retrohepatic  region  encompassing  the  right  upper  quadrant  of  Zones  1  and  2.  Grades  of  injury  have  been  studied,  developed,  and  used  to  categorize  truncal  venous  structures  based  on  the  American  Association  for  the  Surgery  of  Trauma  (AAST)—and  Organ  Injury  Scale  for  Abdominal  Vascular  Injury  (Table  16-1).1