What are the guideline sources, guidelines and references for Abdominal vascular injury ?
Guideline sources The following summarized guidelines for the evaluation and management of abdominal vascular injury are prepared by our editorial team based on guidelines from the Pan-European Multidisciplinary Task Force for Advanced Bleeding Care in Trauma (ABC-T 2023; 2019), the American Heart Association (AHA/ACC 2022), the Society of Interventional Radiology (SIR 2020), the World Society of Emergency Surgery (WSES/AAST 2020), the World Society of Emergency Surgery (WSES 2020; 2017), and the Eastern Association for the Surgery of Trauma (EAST 2012; 2011). 1 2 3 4 5 6 7 8 9 10 11 Guidelines 1. Diagnostic investigations FAST ultrasound: As per EAST 2011 guidelines: Avoid relying on FAST results to exclude intraperitoneal bleeding in the presence of a pelvic fracture. D Rely on FAST results in patients with unstable vital signs and pelvic fracture to decide on laparotomy to control bleeding. A https://web.pathway.md/diseases/recM34Nf88iI65Wd8 1/5 6/23/23, 1:19 AM Abdominal vascular injury Pathway Angiography: As per EAST 2012 guidelines, consider obtaining angiography in patients with AAST grade > III injuries, presence of a contrast blush, moderate hemoperitoneum, or evidence of ongoing splenic bleeding. C As per EAST 2011 guidelines: Consider obtaining pelvic angiography in patients with pelvic fracture and hemodynamic instability or signs of ongoing bleeding after non-pelvic sources of blood loss have been ruled out. B Consider obtaining pelvic angiography in > 60 years old patients with a major pelvic fracture (open book, butterfly segment, or vertical shear), regardless of hemodynamic status. C As per EAST 2011 guidelines: Obtain CT of the abdomen and pelvis with IV contrast to evaluate for intra-abdominal and pelvic bleeding in hemodynamically stable patients with pelvic fracture, regardless of FAST results. B Avoid relying on the absence of contrast extravasation on CT to exclude active bleeding. D 2. Medical management Non-operative management: as per ACC 2022 guidelines, initiate anti-impulse therapy, if clinically tolerated, and obtain repeat imaging within 24-48 hours of the initial imaging to reduce the risk of injury progression in patients with grade 1-2 blunt traumatic abdominal aortic injury without malperfusion. B 3. Therapeutic procedures Pelvic packing: As per ABC-T 2023 guidelines, perform temporary extraperitoneal packing when bleeding is ongoing and/or when angioembolization cannot be achieved promptly. Consider combining extraperitoneal packing with open abdominal surgery when necessary. B As per EAST 2011 guidelines: Perform retroperitoneal pelvic packing as a salvage technique to control hemorrhage after angioembolization in patients with pelvic hemorrhage. B Perform retroperitoneal pelvic packing to control hemorrhage as part of a multidisciplinary clinical pathway including a pelvic orthotic device/C-clamp. B Angioembolization: As per SIR 2020 guidelines: Perform angioembolization as first-line therapy and the standard of care over surgery in patients with pelvic trauma. B Consider performing angioembolization in patients with blunt hepatic injury with ongoing bleeding, identification of an arterial source of bleeding on imaging, or suspicion of a persistent https://web.pathway.md/diseases/recM34Nf88iI65Wd8 2/5 6/23/23, 1:19 AM Abdominal vascular injury Pathway source of arterial bleeding despite operative intervention. C As per WSES 2020 guidelines, consider performing angioembolization as a first-line intervention in hemodynamically stable patients with liver trauma with an arterial blush on CT. C Show 3 more As per ABC-T 2019 guidelines, perform angiographic embolization and/or preperitoneal packing and/or early surgical bleeding control in patients with pelvic trauma and ongoing hemodynamic instability despite adequate pelvic ring stabilization. B As per WSES 2017 guidelines, consider performing angioembolization in patients with pelvic fracture and hemodynamic instability or evidence of ongoing bleeding, after pelvic stabilization, initiation of aggressive hemostatic resuscitation, and exclusion of extra-pelvic sources of blood loss. B Show 3 more As per EAST 2012 guidelines: Consider performing angioembolization as a first-line intervention in patients with liver trauma transiently responding to resuscitation as an adjunct to potential operative intervention. C Consider performing angioembolization in hemodynamically stable patients with liver trauma with evidence of active extravasation (a contrast blush) on abdominal CT. C As per EAST 2011 guidelines, consider performing pelvic angioembolization in patients with pelvic fracture and hemodynamic instability or signs of ongoing bleeding after non-pelvic sources of blood loss have been ruled out. B Show 4 more Resuscitative endovascular balloon occlusion of the aorta: As per ABC-T 2023 guidelines, consider performing REBOA in patients with non-compressible life-threatening traumatic hemorrhage to bridge the gap between hemodynamic collapse and hemorrhage control. C As per ACC 2022 guidelines, insufficient evidence regarding the usefulness of the routine use of REBOA for hemorrhage control in patients with blunt traumatic abdominal aortic injury, and even it may cause harm in some cases. I As per WSES 2020 guidelines, consider performing REBOA as a bridge to other more definitive procedures for hemorrhage control in hemodynamically unstable patients with liver trauma. C As per WSES 2017 guidelines, consider performing REBOA in zone 3 in hemodynamically unstable patients (systolic BP < 90 mmHg or lack of hemodynamic response to blood product transfusion) with suspected pelvic hemorrhage. C Show 3 more 4. Perioperative care Perioperative prophylactic antibiotics: administer a single preoperative dose of prophylactic antibiotics with broad-spectrum aerobic and anaerobic coverage in all patients with penetrating abdominal trauma. A https://web.pathway.md/diseases/recM34Nf88iI65Wd8 3/5 6/23/23, 1:19 AM Abdominal vascular injury Pathway Show 3 more 5. Surgical interventions Damage-control surgery: As per WSES 2017 guidelines: Perform resuscitative thoracotomy with aortic cross-clamping to achieve temporary control of hemorrhage in patients with pelvic trauma and exsanguinating hemorrhage. A Consider performing REBOA as an alternative to aortic cross-clamping. C Definitive repair: as per ACC 2022 guidelines, consider performing repair in patients with grade 2 blunt traumatic abdominal aortic injury and associated malperfusion. C Show 3 more 6. Follow-up and surveillance Serial imaging assessment: Consider obtaining surveillance imaging at intervals appropriate for the repair approach and location in patients with blunt traumatic aortic injury undergone aortic repair. C Consider obtaining surveillance CT at 1 month, 6 months, and 12 months after the diagnosis and, if stable, at appropriate intervals thereafter (depending on the type and extent of the injury) in patients with blunt traumatic aortic injury not undergone repair. C References 1. Goldberg SR, Anand RJ, Como JJ et al. Prophylactic antibiotic use in penetrating abdominal trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov;73 5 Suppl 4 S321 5. Open 2. Donat R Spahn, Bertil Bouillon, Vladimir Cerny et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019 Mar 27;23 1 98. Open 3. Siddharth A Padia, Christopher R Ingraham, John M Moriarty et al. Society of Interventional Radiology Position Statement on Endovascular Intervention for Trauma. J Vasc Interv Radiol. 2020 Mar;31 3 363 369.e2. Open 4. Cullinane DC, Schiller HJ, Zielinski MD et al. Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture update and systematic review. J Trauma. 2011 Dec;71 6 1850 68. Open 5. Leslie Kobayashi, Raul Coimbra, Adenauer M O Goes Jr et al. American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of abdominal vascular injuries. J Trauma Acute Care Surg. 2020 Dec;89 6 1197 1211. Open 6. Nicole A Stassen, Indermeet Bhullar, Julius D Cheng et al. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute https://web.pathway.md/diseases/recM34Nf88iI65Wd8 4/5 6/23/23, 1:19 AM Abdominal vascular injury Pathway Care Surg. 2012 Nov;73 5 Suppl 4 S288 93. Open 7. Federico Coccolini, Raul Coimbra, Carlos Ordonez et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020 Mar 30;15 1 24. Open 8. Coccolini F, Stahel PF, Montori G et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017 Jan 18;12 5. Open 9. Eric M Isselbacher, Ourania Preventza, James Hamilton Black rd et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Nov 2. Open 10. Rolf Rossaint, Arash Afshari, Bertil Bouillon et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023 Mar 1;27 1 80. Open 11. Nicole A Stassen, Indermeet Bhullar, Julius D Cheng et al. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov;73 5 Suppl 4 S294 300. Open 12. Expert Panel on Major Trauma Imaging, Jeffrey Y Shyu, Bharti Khurana et al. ACR Appropriateness Criteria Major Blunt Trauma. J Am Coll Radiol. 2020 May;17 5S S160 S174. Open https://web.pathway.md/diseases/recM34Nf88iI65Wd8 5/5