The ongoing challenge of retroperitoneal vascular injuries.
BACKGROUND
Retroperitoneal vascular injury remains one of the most frequent causes of death following abdominal trauma. A risk analysis of the association between potential outcome predictors and mortality following abdominal aorta and inferior vena cava injuries was performed.


METHODS
Eighty-nine patients sustaining abdominal aortic or inferior vena cava injury were concurrently evaluated for a 10-year period and retrospectively reviewed. A multiple logistic regression model evaluated the following variables:presence of shock on admission, base deficit (< -10 or > or = -10), classification by the organ injury scale (OIS), blood transfusion, crystalloid infusion, total infusion volume, associated injuries, site of injury, and presence of retroperitoneal tamponade.


RESULTS
Overall mortality for all injuries was 57%. Excluding all death on arrival (DOA) patients, the mortality rate decreased to 45.7%. Death following abdominal aortic injuries was significantly associated with free bleeding in the peritoneal cavity, acidosis, and an injury in the suprarenal location (OIS > 4). For inferior vena cava injuries and combined abdominal aortic and inferior vena cava injuries, death was associated with free bleeding, the suprarenal location (OIS = 4), and the presence of shock on admission as well.


CONCLUSIONS
Despite advances in transport and resuscitation, mortality of aortic and vena cava injuries remains unchanged. Shock on admission, bleeding without retroperitoneal tamponade, acidosis, and the suprarenal location each play a significant role in mortality. Immediate identification associated with a rapid surgical approach are the only factors that may improve survival of such devastating injuries.
Coimbra
R
R
Department of Surgery, University of California San Diego 92103-8896, USA.
Hoyt
D
D
Winchell
R
R
Simons
R
R
Fortlage
D
D
Garcia
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000293:injuries*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012307:Risk Factors; D014682:Vena Cava, Inferior / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000401:mortality*; D014950:Wounds, Penetrating / Q000401:mortality*