Trauma to Major Visceral VeinsAn Underemphasized Cause of Accident Mortality
作者:
DAVID COHEN,
KAJ JOHANSEN,
KAREN COTTINGHAM,
KARL CLAYSON,
DAVID SIMONOWITZ,
期刊:
The Journal of Trauma: Injury, Infection, and Critical Care
(OVID Available online 1980)
卷期:
Volume 20,
issue 11
页码: 928-932
ISSN:0022-5282
年代: 1980
出版商: OVID
数据来源: OVID
摘要:
In the period 1970–1978, a mortality rate of 44% resulted in 45 patients who suffered major intra-abdominal venous injuries. An especially grave prognosis accompanied wounds to the inferior vena cava and the hepatic and portal venous systems. Management of damage to major veins presents several difficulties. Exposure is poor; veins tear easily when clamped or sutured; exsanguination can occur as rapidly as with arterial trauma; because of low intraluminal pressure, postoperative chances of thrombosis and occlusion are high; veins (unlike arteries) have no intrinsic vasomotor capabilities to halt bleeding. Finally, the misconception persists that venous wounds are less serious than comparable arterial injuries. Simple pressure by packs or hand often controls bleeding: otherwise clamps, balloons, hemostats, or ligation can be selectively chosen. Our experience suggests that atrial-caval shunting without prior identification and control of the bleeding site is doomed to failure.
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