MAJOR ABDOMINAL VASCULAR INJURIES

In this study 29 patients were retrospectively evaluated who were operated for abdominal vascular injuries in our clink between 1986 and 1998 in order to detect the factors affecting morbidity and mortality in patients undergoing surgery due to the abdominal vascular injury. Out of 29 patients 21 were male and 8 female and the average age was 32 years. The cause of the injury was blunt in 6 patients and penetrating in 23 patients. The average time from field notification to patients arrival in the emergency department was 65 minutes, from emergency department to arrival to operating room was 34 minutes. Mean trauma severity score was 19.7. The mean blood requirements in these patients was 5500 ml in the preoperative period. The inferior vena cava, abdominal aorta and iliac veins were injured most frequently. While more than one abdominal vascular injury was determined in 8 patients, 34 associated intraabdominal organ injuries including mostly small intestine and colon were found in 21 patients. Treatment including simple suture (n =31), ligation (n =5), and dacron grafts (n=3). The mortality rate was higher in abdominal aorta and vena cava injuries compared to other vascular injuries. The overall mortality rate was 41%. In conclusion, despite the increasing experience in vascular repair methods and surgical explorations carried out without delay major abdominal vascular injuries threatening the life still result in high operative mortality.

ABDOMÝNAL BÜYÜK DAMAR YARALANMALARI

Bu çalýþmada abdominal büyük damar yaralanmasý nedeniyle cerrahi geçiren hastalardaki morbidite ve mortaliteyi etkileyen faktörleri araþtýrmak için kliniðimizde 1986-1998 yýllarý arasýnda abdominal büyük damar yaralanmasý nedeniyle ameliyat edilen 29 hasta retrospektif olarak incelendi. Hastalarýn 21'i erkek 87 kadýn, genel yaþ ortalamasý 32 idi. Yaralanmanýn nedeni 6 hastada künt, 23 hastada ise penetran idi. Yaralanmadan sonra hastalarýn acil servise geliþ süreleri ortalama 65 dakika iken, acil servisten ameliyata kadar geçen süre ortalama 34 dakika idi. Hastalarýn ortalama travma þiddet skoru 19.7olarak tespit edildi. Hastalara peroperatuvar dönemde ortalama 5500 mL kan transfüzyonu yapýldý. Vena kava inferior, abdominal aorta ve iliak venler en sýk yaralanan damarlar idi. Birden fazla abdominal damar yaralanmasý 8 hastada tespit edilirken, 21 hastada sýklýkla ince barsak ve kolon olmak üzere 34 adet ilave intraabdominal organ yaralanmasý bulundu. Tedavide 31 hastaya basit sütürasyon, 5 hastaya ligasyon ve 3 hastaya dacron greft uygulandý. Abdominal aorta ve vena kava inferior yaralanmalarýnda mortalite diðer yaralanmalara göre daha yüksek olup serideki aperatif mortalite ortalama %41 idi. Sonuç olarak vasküler tamir tekniklerindeki artan tecrübeye, gecikmeksizin uygulanan cerrahi eksplorasyona raðmen hayatý tehdit eden abdominal büyük damar yaralanmalarý hala yüksek operatif mortalite ile sonuçlanmaktadýr.