The last review of abdominal vascular trauma by David V. Feliciano in Surgical Clinics of North America (1988) was a superb analysis of the clinical problem. In that review a systematic approach to these life-threatening injuries was emphasized. The surgeon was advised to be guided in critical intraoperative decision making by the location of the hematoma. Feliciano's practical review described in detail specific maneuvers and techniques that are critical in expeditiously managing these complicated problems.<sup>16 Feliciano D.V. Abdominal vascular injuries Surg Clin North Am 1988 ;  68 : 741-751

Cliccare qui per andare alla sezione Riferimenti</sup> This article is intended to supplement Feliciano's earlier review. An emphasis is placed on updating new ideas since 1988 regarding managing these difficult patients and further elaborating on blunt trauma injuries.

Hemorrhagic shock is the most common immediate cause of death in patients with abdominal vascular injuries. During the initial evaluation of an injured patient in the emergency department, the trauma surgeon must rapidly determine if the injured patient has life-threatening intra-abdominal hemorrhage and promptly proceed with control of bleeding. The surgeon must immediately perform three tasks during celiotomy to avert exsanguinating hemorrhage within the abdomen.<sup>13 Ekbom G.A., Towne J.B., Majewski J.T. , e al. Intra-abdominal vascular trauma—A need for prompt operation J Trauma 1981 ;  21 : 1040-1044  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Location of the vessel or vessels injured is identified. Surgical exposure of injured vessels is achieved. Hemostasis and restoration of critical blood flow are accomplished. Bleeding arteries or veins can either be repaired or ligated; the surgeon's decision is influenced by the benefits of immediate hemostasis compared with the risks of ischemia. Reconstruction of vessels in a field contaminated with enteric contents complicates the decisions regarding the optimal replacement conduit. Increasing emphasis in the recent literature is placed on a staged approach to patients with severe intra-abdominal injuries. In the initial operation, the goals are to control hemorrhage and re-establish critically required reperfusion of viscera. Surgery is then stopped after packing the abdomen and the patient is returned to the intensive care unit, where hours may be required to reverse coagulopathy, hypothermia, and acidosis before the patient is returned to the operating room for repair and management of additional injuries.<sup>21 Kashuk J.L., Moore E.E., Millikan J.S. , e al. Major abdominal vascular trauma—A unified approach J Trauma 1982 ;  22 : 672-679  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup>

This article discusses anatomic regions within the abdomen where life-threatening vascular injuries occur. The pathophysiologic and diagnostic issues involved with each region are reviewed. Techniques are described for optimal exposure of major abdominal arteries and veins. Methods for managing vascular injuries are summarized.