Rutherford's 182: Vascular Trauma: Abdominal. скачать в хорошем качестве

Rutherford's 182: Vascular Trauma: Abdominal.

#AbdominalVascularTrauma #TraumaSurgery #VascularSurgery #RutherfordsVascular #MedicalEducation #EmergencyMedicine #SurgicalAnatomy #DamageControl #Endovascular #IVCInjury This video, based on Rutherford's Vascular Surgery and Endovascular Therapy textbook, explores the critical area of abdominal vascular trauma, which is immediately life-threatening and a leading cause of death after penetrating abdominal injury. The discussion maps out key surgical anatomy, dividing the abdomen into intraperitoneal and retroperitoneal areas, with the retroperitoneum further split into four crucial zones containing major vessels. It covers the incidence, noting that penetrating trauma is most common (approx. 90% in urban centres), and major vascular injury is found in a significant percentage of trauma laparotomies (e.g., 14.3% for gunshot wounds). Blunt trauma also causes injury through deceleration, crushing, or bone fragments. Arterial and venous injuries occur in almost equal measure. The most frequently injured vessels are the IVC (25%), aorta (21%), iliac arteries (20%), iliac veins (17%), SMV (11%), and SMA (10%). Multiple vascular injuries are common, especially with penetrating trauma. Presentation varies, from profound shock (marked hypotension, distended abdomen) to initial stability if bleeding is contained. Diagnosis depends on patient stability; unstable penetrating trauma requires immediate surgery, while stable patients benefit from CT angiography. Blunt trauma assessment may involve FAST exams, CT scans, or angiography for suspected limb ischemia. Treatment principles include rapid transport to a trauma centre. In the emergency department, resuscitation may involve concepts like controlled hypotension and techniques like Resuscitative Endovascular Balloon Occlusion of the Aorta (ReboA). Surgical management in the operating room prioritises preventing hypothermia, massive transfusion protocols, and rapid exposure for bleeding control. Retroperitoneal hematomas from penetrating injury are usually explored, while blunt hematomas may not be, depending on location and signs of ongoing bleeding. Damage control surgery is vital for critically ill patients, focusing on rapid bleeding control (ligation, temporary shunts) before temporary closure and transfer to the ICU for resuscitation, followed by definitive repair later. Avoiding primary abdominal closure in damage control patients helps prevent abdominal compartment syndrome. Endovascular techniques (embolization, stenting) are increasingly used for specific injuries, facilitated by hybrid operating rooms. Abdominal compartment syndrome is a critical complication requiring recognition and surgical decompression. Specific surgical approaches and repair options exist for injuries to the aorta, SMA, renal vessels, iliacs, IVC, and portal system, often involving complex decisions between repair and ligation. Despite advances, mortality remains high, underscoring the need for speed, precision, anatomical knowledge, and a multidisciplinary team approach.