Abdominal vascular injuries: Blunt vs. penetrating

• Published in: Injury 2019-01, Vol.50 (1), p.137-141
• Main Authors: Prichayudh, Supparerk, Rassamee, Pattanapong, Sriussadaporn, Suvit, Pak-art, Rattaplee, Sriussadaporn, Sukanya, Kritayakirana, Kritaya, Samorn, Pasurachate, Narueponjirakul, Natawat, Uthaipaisanwong, Apinan
• Format: Article
• Language: English
• Subjects: Abdominal vascular injury; Blunt injury; Penetrating injury
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2018.11.045

•Regarding the difference in demographic data, the present study demonstrated that blunt abdominal vascular injury (AVI) patients were older and had higher Injury Severity Score than penetrating AVI patients.•Regarding the difference in pathology, the present study demonstrated that blunt AVI patients had more internal iliac artery injuries; while penetrating AVI patients had more aortic injuries and inferior vena cava injuries.•The present study demonstrated that both blunt and penetrating AVI patients carried high mortality rates, mainly from exsanguination, emphasizing the need for prompt operative intervention to control hemorrhage and the use of damage control surgery in AVI patients. Introduction: Abdominal vascular injuries (AVIs) remain a great challenge since they are associated with significant mortality. Penetrating injury is the most common cause of AVIs; however, some AVI series had more blunt injuries. There is little information regarding differences between penetrating and blunt AVIs. The objective of the present study was to identify the differences between these two mechanisms in civilian AVI patients in terms of patient’s characteristics, injury details, and outcomes. Method: From January 2007 to January 2016, we retrospectively collected the data of AVI patients at King Chulalongkorn Memorial hospital, including demographic data, details of injury, the operative managements, and outcomes in terms of morbidity and mortality. The comparison of the data between blunt and penetrating AVI patients was performed. Results: There were 55 AVI patients (28 blunt and 27 penetrating). Majority (78%) of the patients in both groups were in shock on arrival. Blunt AVI patients had significantly higher injury severity score (mean(SD) ISS, 36(20) vs. 25(9), p = 0.019) and more internal iliac artery injuries (8 vs. 1, p = 0.028). On the other hand, penetrating AVI patients had more aortic injuries (5 vs. 0, p = 0.046), and inferior vena cava injuries (7 vs. 0, p = 0.009). Damage control surgery (DCS) was performed in 45 patients (82%), 25 in blunt and 20 in penetrating. The overall mortality rate was 40% (50% in blunt vs. 30% in penetrating, p = 0.205). Conclusions: Blunt AVI patients had higher ISS and more internal iliac artery injuries, while penetrating AVI patients had more aortic injuries and vena cava injuries. Majority of AVI patients in both groups presented with shock and required DCS.