THE ONGOING CHALLENGE OF RETROPERITONEAL VASCULAR INJURIES

BACKGROUND: Retroperitoneal vascular injury remains one of the most fr equent causes of death following abdominal trauma, A risk analysis of the association between potential outcome predictors and mortality fol lowing abdominal aorta and inferior vena cava injuries was performed. METHODS: Eighty-nine patients sustaining abdominal aortic or inferior vena cava injury were concurrently evaluated for a 10-year period and retrospectively reviewed, A multiple logistic regression model evaluat ed the following variables:presence of shock on admission, base defici t (<-10 or greater than or equal to-10), classification by the organ i njury scale (OIS), blood transfusion, crystalloid infusion, total infu sion volume, associated injuries, site of injury, and presence of retr operitoneal tamponade. RESULTS: Overall mortality for all injuries was 57%. Excluding all death on arrival (DOA) patients, the mortality rat e decreased to 45.7%, Death following abdominal aortic injuries was si gnificantly associated with free bleeding in the peritoneal cavity, ac idosis, and an injury in the suprarenal location (OIS >4). For inferio r vena cava injuries and combined abdominal aortic and inferior vena c ava injuries, death was associated with free bleeding, the suprarenal location (OIS = 4), and the presence of shock on admission as well. CO NCLUSIONS: Despite advances in transport and resuscitation, mortality of aortic and vena cava injuries remains unchanged, Shock on admission , breeding without retroperitoneal tamponade, acidosis, and the suprar enal location each play a significant role in mortality. Immediate ide ntification associated with a rapid surgical approach are the only fac tors that may improve survival of such devastating injuries. (C) 1996 by Excerpta Medica, Inc.