Prise en charge des lésions vasculaires lors de traumatismes pénétrants de l'abdomen. Plaies vasculaires de l'abdomen

Vascular injury due to penetrating abdominal trauma is a major challenge for trauma teams. Arterial and venous injuries occur with equal frequency. Treatment depends on the hemodynamic status of the patient: under stable conditions, angiography can be envisioned, whereas instability is an indication for immediate surgery; abbreviated laparotomy is the most frequent procedure. As complete surgical exploration may lead to fatal outcome, the surgeon must be prepared to perform perihepatic or pelvic packing and employ endovascular techniques as appropriate. However, when faced with uncontrolled hemorrhage, the surgeon also has to be prepared to explore all central retroperitoneal hematomas, retroperitoneal hematoma located in the flanks except when stable in the hemodynamically unstable patient, and those in the pelvis only if the patient is stable. Since it is more critical to control hemorrhage than to avoid end-organ ischemia, vascular ligation is more commonly used than other techniques. However, survival is very low in these severely wounded patients.