The incidence, treatment and evolution of vascular injuries in high-grade blunt abdominal solid organ trauma.

Abstract

Vascular injury is a major risk factor for acute and delayed haemorrhage in blunt solid organ trauma. However, the natural history, including spontaneous resolution, remains poorly described. This study evaluated the incidence, detection timing, treatment, spontaneous resolution, and outcomes of vascular injury in high-grade blunt solid organ trauma. A retrospective cohort study of patients with Grade III or higher splenic, hepatic, or renal injuries (2018-2023) at Western Australia's single adult major trauma centre was conducted. We recorded rates of surgery, angioembolisation, delayed haemorrhage, and the development and regression of vascular injury. 460 patients with 487 high grade solid organ injuries were admitted during the study period. Vascular injury was noted in 62.2 % of splenic injuries (n = 145/233); 24.1 % of hepatic injuries (n = 32/133) and 21.5 % of renal injuries (n = 26/121). Successful angioembolisation occurred in 61.4 % of splenic vascular injury (n = 89), 10/32 liver vascular injury and 8/26 renal vascular injury. 19 splenectomies were performed (8.2 %). Untreated vascular injury was reported in 41 splenic injuries (28.3 % of vascular injury); 13 hepatic and 15 renal injuries. Three cases of delayed haemorrhage occurred, two splenic and one hepatic; there were no clear uniting factors. Vascular injury is common in high-grade blunt solid organ trauma, particularly splenic injury. Interval inpatient imaging detects clinically relevant new vascular injury, and a substantial proportion resolve without intervention. Given the low delayed haemorrhage rate, universal post-discharge follow-up imaging seems excessive.