Management of intra-abdominal vascular injury in trauma laparotomy: a South African experience

Intra-abdominal vascular injury (IAVI) is uncommon but continues to be associated with high mortality rates despite technological advances in the past decades. In light of these ongoing developments, we reviewed our contemporary experience with IAVI in an attempt to clarify and refine our management strategies and the outcome of these patients. We retrospectively reviewed the charts of all patients admitted between January 2011 and December 2014 at a major trauma centre in South Africa who were found to have an IAVI during laparotomy for trauma. We collected demographic and clinical data including mechanism of injury, location and severity of the injury, concurrent injuries, physiologic parameters and clinical outcome. We identified 110 patients with IAVIs, of whom 98 had sustained penetrating injuries (55 gunshot wounds and 43 stab wounds). There were 84 arterial injuries (including 21 renal and 17 mesenteric) and 74 venous injuries (including 21 renal and 17 inferior vena caval). Combined venous and arterial injuries were found in almost one-third of patients (34 [30.9%]). Fifty-seven patients (51.8%) required intensive care admission. The overall mortality rate was 28.2% (31 patients); the rate was 62% for aortic injuries and 47% for inferior vena cava injuries. Liver injury, large bowel injury, splenic injury and elevated lactate level were all associated with a statistically significantly higher mortality rate. The mortality rate for IAVI remains high despite decades of operative experience in high-volume centres. Open operative techniques alone are unlikely to achieve further reduction in mortality rates. Integration of endovascular techniques may provide an alternative strategy to improve outcomes.