Abdominal Vascular Injuries Workup

Updated: Oct 06, 2016
  • Author: Stephen A Tonks, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
  • Print
Workup

Approach Considerations

Hemodynamically unstable patients with penetrating trauma should be transported immediately to the operating room (OR); no imaging studies are necessary.

The assessment of hemodynamically unstable patients with blunt trauma to the abdomen may include focused assessment with sonography for trauma (FAST) or diagnostic peritoneal lavage (DPL) to confirm hemoperitoneum as well as portable chest radiography only if expeditious transport to the OR is not to be interrupted.

Abdominal exploration is indicated in essentially all patients with a GSW to the abdomen.  

Stable patients with stab wounds may undergo laparoscopy to confirm peritoneal penetration. If time permits, chest and pelvic radiography may be beneficial to exclude bleeding into the chest and pelvic fracture.

Hemodynamically stable patients with blunt trauma and suspected abdominal vascular injuries may benefit from abdominal computed tomography (CT) scanning, which helps localize a hematoma and evaluate solid organ injuries. [6, 7, 8, 9, 10]

A retrospective study by Benjamin et al suggested that negative CT finding for an asymptomatic patient after blunt abdominal trauma is sufficient to exclude major intra-abdominal injury. [11, 12]

Angiography with or without embolization may be considered in stable patients, particularly in patients with blunt trauma.

Also see Focused Assessment with Sonography in Trauma (FAST).

Next:

Grading

Once exposure and proximal and distal control have been obtained, all abdominal vascular injuries should be graded according to the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) for vascular injuries (see the table below).

Table 1. American Association for the Surgery of Trauma Organ Injury Scale for Vascular Injuries (Open Table in a new window)

OIS

Grade*

Artery Injured

Vein Injured

II

Hepatic

Splenic

Gastric

Gastroduodenal

Inferior mesenteric

Primary named vessels of superior mesenteric

Splenic

Inferior mesenteric

III

Renal

Iliac

Hypogastric

Superior mesenteric

Renal

Iliac

Hypogastric

Vena cava (infrarenal)

IV

Superior mesenteric (trunk)

Celiac axis

Aorta (infrarenal)

Vena cava (infrahepatic)

V

Aorta (suprarenal)

Vena cava (suprahepatic)

Vena cava (retrohepatic)

Portal

Hepatic (extrahepatic)

* Grade I injury includes the following: No named superior mesenteric artery or superior mesenteric vein branches; nonnamed inferior mesenteric artery or inferior mesenteric vein branches; phrenic artery/vein; lumbar artery/vein; gonadal artery/vein; ovarian artery/vein; other nonnamed small arterial or venous structures requiring ligation.

Previous