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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 4/2012

01-08-2012 | Original Article

Iliac vessel injuries: difficult injuries and difficult management problems

Authors: M. Ksycki, G. Ruiz, A. J. Perez-Alonso, J. D. Sciarretta, R. Gonzalo, E. Iglesias, A. Gigena, T. Vu, J. A. Asensio

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2012

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Abstract

Introduction

Injury to the iliac vessels poses a serious and frustrating treatment dilemma for all trauma surgeons. Generally, patients present in profound shock secondary to severe hemorrhage from either iliac arterial, venous, or combined injuries. Despite improvements in our emergency medical services (EMS), rapid transport, standard training of trauma surgeons, and improved technology, the morbidity and mortality from iliac vessel injuries remain high, ranging from 25 to 40 %.

Materials and methods

A systematic review of the literature, with emphasis placed on the diagnosis, treatment, and outcomes of these injuries, incorporating the author’s experience.

Conclusions

Injuries to the iliac vessel remain a daunting task, even after great advances in anatomic injury grading and damage control as well as advances in surgical techniques and critical care. Despite all the advances in treatment and appropriate management strategies, the morbidity and mortality from iliac vessel injuries remain high, demonstrating the complex challenge their treatment presents to even the modern-day trauma surgeon.
Literature
1.
Rich NM, Spencer FC. Historical aspects of vascular trauma (Chap 1). In: Rich NM, Spencer FC, editors. Vascular trauma, 1st ed. Philadelphia: W.B. Saunders; 1978. p. 3–21.
2.
Rich NM, Mattox KL, Hirshberg A. Historical and military aspects of vascular trauma (with lifetime reflections of Dr. Norman Rich) (Chap 1). In: Rich NM, Mattox KL, Hirshberg A, editors. Vascular trauma, 2nd ed. Philadelphia: Elsevier; 2004. p. 3–72.
3.
Schwartz A. The historical development of methods of hemostasis. Surgery. 1958;44:604.PubMed
4.
Hallowell. Extract of a letter from Mr. Lambert, surgeon at Newcastle upon Tyne, to Dr. Hunter, giving an account of new method of treating an aneurysm. Med Obser Inq. 1762;30:360.
5.
Murphy J. Resection of arteries and veins injured in continuity end-to-end suture. Exp Clin Res Med Rec. 1897;51:73–104.
6.
Goyanes J. Nuevos trabajos de cirugía vascular: Sustitución plástica de las arterias por las venas, o arterio-plastia venosa, aplicado, como nuevo metodo, al tratamiento de los aneurismas. El Siglo Med. 1906;53:546–61.
7.
Soubbotich V. Military experiences of traumatic aneurysms. Lancet. 1913;2:720–1.CrossRef
8.
La Carrel A. Technique opératories des anastomoses vasculaires et la transplantation des viscéres. Lyon Medical. 1902;98:859.
9.
Carrel A, Guthrie CC. Uniterminal and biterminal venous transplantations. Surg Gynecol Obstet. 1906;2:266–86.
10.
Makins G. Gunshot injuries to the blood vessels. Bristol: John Wright and Sons; 1919.
11.
Makins G, Howard JM, Green R. Arterial injuries complicating fractures and dislocations: the necessity for a more aggressive approach. Surgery. 1966;59:203–9.
12.
DeBakey ME, Simeone FA. Battle injuries of the arteries in World War I—an analysis of 2,471 cases. Ann Surg. 1946;123(4):534–79.CrossRef
13.
Jahnke EJ Jr. Late structural and functional results of arterial injuries primarily repaired. Surgery. 1958;43:175–83.PubMed
14.
Jahnke EJ Jr. Seeley SF: acute vascular injuries in the Korean War: an analysis of 77 consecutive cases. Ann Sur. 1953;138:158–77.CrossRef
15.
Hughes CW. Arterial repair during the Korean War. Ann Surg. 1958;147(4):555–61.PubMed
16.
Hughes CW. Acute vascular trauma in Korean War casualties—an analysis of 180 cases. Surg Gynecol Obstet. 1954;99(1):91–100.PubMed
17.
Hughes CW. The primary repair of wounds of major arteries: an analysis of experience in Korea in 1953. Ann Surg. 1955;141:297–303.PubMedCrossRef
18.
Hughes CW. Vascular surgery in the armed forces. Milit Med. 1959;124:30–46.
19.
Rich NM, Baugh JH, Hughes CW. Acute arterial injuries in Vietnam: 1,000 cases. J Trauma. 1970;10(5):359–69.PubMedCrossRef
20.
Rich NM. Vietnam missile wounds evaluated in 750 patients. Milit Med. 1968;133:9–22.
21.
Rich NM. Vascular trauma in Vietnam. J Cardiovascular Surg. 1970;11:368–77.
22.
Rich NM, Hughes CW. Vietnam vascular registry: a preliminary report. Surgery. 1969;65:218–26.PubMed
23.
Mattox KL, Feliciano DV, Burch J, Beall AC, Jordan GL, Debakey ME. 5,760 cardiovascular injuries in 4,459 patients—epidemiologic evolution 1958 to 1987. Ann Surg. 1989;209(6):698–707.PubMedCrossRef
24.
Bongard F, Dubrow T, Klein S. Vascular injuries in the urban battleground. Experience at a metropolitan trauma center. Ann Vasc Surg. 1990;4(5):415–8.PubMedCrossRef
25.
Asensio J, Chahwan S, Hanpeter D, Demetriades D, Forno W, Gambaro E, et al. Operative management and outcome of 302 abdominal vascular injuries. Am J Surg. 2000;6(December):528–33.CrossRef
26.
Davis TP, Feliciano DV, Rozycki GS, Bush JB, Ingram WL, Salomone JP, et al. Results with abdominal vascular trauma in the modern era. Am Surg. 2001;67(6):565–70. (discussion 70-1).PubMed
27.
Tyburski JG, Wilson RF, Dente C, Steffes C, Carlin AM. Factors affecting mortality rates in patients with abdominal vascular injuries. J Trauma. 2001;50(6):1020–6.PubMedCrossRef
28.
Paul JS, Webb TP, Aprahamian C, Weigelt JA. Intraabdominal vascular injury: are we getting any better? J Trauma. 2010;69(6):1393–7.PubMedCrossRef
29.
Clouse WD, Rasmussen TE, Peck MA. In-theater management of vascular injury: 2 years of the balad vascular registry. J Am Coll Surg. 2007;204:625–32.PubMedCrossRef
30.
White JM, Stannard A, Burkhardt GE, Eastridge BJ, Blackbourne LH, Rasmussen TE. The epidemiology of vascular injury in the wars in Iraq and Afghanistan. Ann Surg. 2011;253(6):1184–9.PubMedCrossRef
31.
Asensio JA, Petrone P, Roldan G, Kuncir E, Rowe VL, Chan L, et al. Analysis of 185 iliac vessel injuries: risk factors and predictors of outcome. Arch Surg. 2003;138(11):1187–93. (discussion 93-4).PubMedCrossRef
32.
Standring S. Gray’s anatomy: the anatomical basis of clinical practice, expert consult. 40th ed. London: Churchill Livingstone; 2008.
33.
Wilson RF, Wiencek RG, Balog M. Factors affecting mortality rate with iliac vein injuries. J Trauma. 1990;30(3):320–3.PubMedCrossRef
34.
Cushman JG, Feliciano DV, Renz BM, Ingram WL, Ansley JD, Clark WS, Rozycki GS. Iliac vessel injury: operative physiology related to outcome. J Trauma. 1997;42(6):1033–40.PubMedCrossRef
35.
Haan J, Rodriguez A, Chiu W, Boswell S, Scott J, Scalea T. Operative management and outcome of iliac vessel injury: a ten-year experience. Am Surg. 2003;69(7):581–6.PubMed
36.
Carrillo EH, Spain DA, Wilson MA, Miller FB, Richardson JD. Alternatives in the management of penetrating injuries to the iliac vessels. J Trauma. 1998;44(6):1024–9. (discussion 9-30).PubMedCrossRef
37.
38.
Millikan JS, Moore EE, Van Way CW III, Kelly GL. Vascular trauma in the groin: contrast between iliac and femoral injuries. Am J Surg. 1981;142(6):695–8.PubMedCrossRef
39.
Ryan W, Snyder W, 3rd, Bell T, Hunt J. Penetrating injuries of the iliac vessels. Early recognition and management. Am J Surg. 1982;144(6):642–5.PubMedCrossRef
40.
Sirinek KR, Gaskill HV, Dittman WI, Levine BA. Exclusion angiography for patients with possible vascular injuries to the extremities: a better use of trauma center resources. Surgery. 1983;94(4):598–603.PubMed
41.
Burch JM, Richardson RJ, Martin RR, Mattox KL. Penetrating iliac vascular injuries: recent experience with 233 consecutive patients. J Trauma. 1990;30(12):1450–9.PubMedCrossRef
42.
Jasmeet P, Travis W. Intraabdominal vascular injury: are we getting any better? J Trauma. 2010;69(6):1393–7.
Metadata
Title
Iliac vessel injuries: difficult injuries and difficult management problems
Authors
M. Ksycki
G. Ruiz
A. J. Perez-Alonso
J. D. Sciarretta
R. Gonzalo
E. Iglesias
A. Gigena
T. Vu
J. A. Asensio
Publication date
01-08-2012
Publisher
Springer-Verlag
Published in
European Journal of Trauma and Emergency Surgery / Issue 4/2012
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-012-0189-7

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