Skip to main content
Erschienen in: European Journal of Trauma and Emergency Surgery 4/2012

01.08.2012 | Original Article

Iliac vessel injuries: difficult injuries and difficult management problems

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

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 4/2012

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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. 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.
Zurück zum Zitat Schwartz A. The historical development of methods of hemostasis. Surgery. 1958;44:604.PubMed Schwartz A. The historical development of methods of hemostasis. Surgery. 1958;44:604.PubMed
4.
Zurück zum Zitat 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. 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.
Zurück zum Zitat Murphy J. Resection of arteries and veins injured in continuity end-to-end suture. Exp Clin Res Med Rec. 1897;51:73–104. Murphy J. Resection of arteries and veins injured in continuity end-to-end suture. Exp Clin Res Med Rec. 1897;51:73–104.
6.
Zurück zum Zitat 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. 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.
Zurück zum Zitat Soubbotich V. Military experiences of traumatic aneurysms. Lancet. 1913;2:720–1.CrossRef Soubbotich V. Military experiences of traumatic aneurysms. Lancet. 1913;2:720–1.CrossRef
8.
Zurück zum Zitat La Carrel A. Technique opératories des anastomoses vasculaires et la transplantation des viscéres. Lyon Medical. 1902;98:859. La Carrel A. Technique opératories des anastomoses vasculaires et la transplantation des viscéres. Lyon Medical. 1902;98:859.
9.
Zurück zum Zitat Carrel A, Guthrie CC. Uniterminal and biterminal venous transplantations. Surg Gynecol Obstet. 1906;2:266–86. Carrel A, Guthrie CC. Uniterminal and biterminal venous transplantations. Surg Gynecol Obstet. 1906;2:266–86.
10.
Zurück zum Zitat Makins G. Gunshot injuries to the blood vessels. Bristol: John Wright and Sons; 1919. Makins G. Gunshot injuries to the blood vessels. Bristol: John Wright and Sons; 1919.
11.
Zurück zum Zitat Makins G, Howard JM, Green R. Arterial injuries complicating fractures and dislocations: the necessity for a more aggressive approach. Surgery. 1966;59:203–9. 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Jahnke EJ Jr. Late structural and functional results of arterial injuries primarily repaired. Surgery. 1958;43:175–83.PubMed Jahnke EJ Jr. Late structural and functional results of arterial injuries primarily repaired. Surgery. 1958;43:175–83.PubMed
14.
Zurück zum Zitat 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 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.
Zurück zum Zitat Hughes CW. Arterial repair during the Korean War. Ann Surg. 1958;147(4):555–61.PubMed Hughes CW. Arterial repair during the Korean War. Ann Surg. 1958;147(4):555–61.PubMed
16.
Zurück zum Zitat Hughes CW. Acute vascular trauma in Korean War casualties—an analysis of 180 cases. Surg Gynecol Obstet. 1954;99(1):91–100.PubMed Hughes CW. Acute vascular trauma in Korean War casualties—an analysis of 180 cases. Surg Gynecol Obstet. 1954;99(1):91–100.PubMed
17.
Zurück zum Zitat 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 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.
Zurück zum Zitat Hughes CW. Vascular surgery in the armed forces. Milit Med. 1959;124:30–46. Hughes CW. Vascular surgery in the armed forces. Milit Med. 1959;124:30–46.
19.
Zurück zum Zitat Rich NM, Baugh JH, Hughes CW. Acute arterial injuries in Vietnam: 1,000 cases. J Trauma. 1970;10(5):359–69.PubMedCrossRef Rich NM, Baugh JH, Hughes CW. Acute arterial injuries in Vietnam: 1,000 cases. J Trauma. 1970;10(5):359–69.PubMedCrossRef
20.
Zurück zum Zitat Rich NM. Vietnam missile wounds evaluated in 750 patients. Milit Med. 1968;133:9–22. Rich NM. Vietnam missile wounds evaluated in 750 patients. Milit Med. 1968;133:9–22.
21.
Zurück zum Zitat Rich NM. Vascular trauma in Vietnam. J Cardiovascular Surg. 1970;11:368–77. Rich NM. Vascular trauma in Vietnam. J Cardiovascular Surg. 1970;11:368–77.
22.
Zurück zum Zitat Rich NM, Hughes CW. Vietnam vascular registry: a preliminary report. Surgery. 1969;65:218–26.PubMed Rich NM, Hughes CW. Vietnam vascular registry: a preliminary report. Surgery. 1969;65:218–26.PubMed
23.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Paul JS, Webb TP, Aprahamian C, Weigelt JA. Intraabdominal vascular injury: are we getting any better? J Trauma. 2010;69(6):1393–7.PubMedCrossRef 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Standring S. Gray’s anatomy: the anatomical basis of clinical practice, expert consult. 40th ed. London: Churchill Livingstone; 2008. Standring S. Gray’s anatomy: the anatomical basis of clinical practice, expert consult. 40th ed. London: Churchill Livingstone; 2008.
33.
Zurück zum Zitat Wilson RF, Wiencek RG, Balog M. Factors affecting mortality rate with iliac vein injuries. J Trauma. 1990;30(3):320–3.PubMedCrossRef Wilson RF, Wiencek RG, Balog M. Factors affecting mortality rate with iliac vein injuries. J Trauma. 1990;30(3):320–3.PubMedCrossRef
34.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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
38.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Jasmeet P, Travis W. Intraabdominal vascular injury: are we getting any better? J Trauma. 2010;69(6):1393–7. Jasmeet P, Travis W. Intraabdominal vascular injury: are we getting any better? J Trauma. 2010;69(6):1393–7.
Metadaten
Titel
Iliac vessel injuries: difficult injuries and difficult management problems
verfasst von
M. Ksycki
G. Ruiz
A. J. Perez-Alonso
J. D. Sciarretta
R. Gonzalo
E. Iglesias
A. Gigena
T. Vu
J. A. Asensio
Publikationsdatum
01.08.2012
Verlag
Springer-Verlag
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 4/2012
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-012-0189-7

Weitere Artikel der Ausgabe 4/2012

European Journal of Trauma and Emergency Surgery 4/2012 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.