Management of Penetrating Trauma to the Major Abdominal Vessels

Penetrating abdominal vascular injuries result in significant mortality. In the pre-hospital phase of care, “scoop and run” is the optimal strategy while on-scene interventions are restricted only to basic airway maneuvers. Early in-hospital diagnosis and operative interventions are prerequisites for survival in vascular trauma. Hypotension and peritonitis following penetrating abdominal trauma mandate immediate access to the operating room with vascular surgery capabilities. Patients presenting in extremis should be managed with a resuscitative thoracotomy in the emergency department. The majority of abdominal vascular injuries surviving to the operating room are subjected to damage control intervention. In hemodynamically stable patients, diagnostic modality of choice is computed tomography angiography and endovascular interventions are evolving.