Results with abdominal vascular trauma in the modern era

This is a report of a 10-year experience (1989-1998) with 300 consecutive p atients found to have an injury to a named abdominal vessel at the time of an exploratory laparotomy for trauma. An abdominal gunshot wound was the me chanism of injury in 78 per cent of patients, and injury to more than one n amed abdominal vessel was present in 42 per cent. The abdominal aorta, infe rior vena cava, and external iliac artery and vein were the most commonly i njured vessels. When management for the five most commonly injured arteries was grouped, exsanguination before attempts at repair occurred in 11 to 15 per cent of patients and the mean survival in the remainder was 46 per cen t. When management for the five most commonly injured veins was grouped, ex sanguination before attempts at repair occurred in 5 per cent of patients a nd the mean survival in the remainder was 64 per cent. A number of administ rative and medical changes in the management of patients with abdominal tra uma occurred from 1992 through 1994. Despite significantly increased Injury Severity Scores for patients treated from 1993 through 1998 as compared wi th those treated from 1989 through 1992 survival rates for patients with in juries to the abdominal aorta and inferior vena cava were unchanged. Surviv al rates for injuries to the external iliac artery and vein increased signi ficantly The local changes in management should be considered for prospecti ve studies in other urban trauma centers.