Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-05T19:43:29.533Z Has data issue: false hasContentIssue false
This chapter is part of a book that is no longer available to purchase from Cambridge Core

15 - Vascular trauma

Robbie George
Affiliation:
Royal Victoria Hospital, UK
Paul Blair
Affiliation:
Royal Victoria Hospital, UK
Vish Bhattacharya
Affiliation:
Queen Elizabeth Hospital
Gerard Stansby
Affiliation:
Freeman Hospital
Get access

Summary

Key points

  • Remember the whole patient, do not just focus on the vascular injury

  • Time is of the essence, avoid delay

  • Do not attempt to mobilise large veins, use local pressure

  • Consider temporary intravascular shunts in complex limb injuries

  • Consider damage limitation surgery in patients developing hypothermia or acidosis

Trauma is a leading cause of mortality in the first four decades of life. Vascular surgeons are often involved in the management of a multiply-injured patient who may have limb- and/or life-threatening vascular injuries. In addition the extended range of procedures carried out by open and minimally invasive surgical and radiological techniques has created its own unique set of vascular injuries. It is beyond the scope of this short chapter to deal with specific vascular injuries in detail, however, general principles will be discussed with specific details given in the more common sites of injury.

General considerations

Vascular trauma can occur as a result of a variety of mechanisms including penetrating, blunt, crush, irradiation and a variety of iatrogenic injuries. The majority of penetrating injuries in civilian life in the UK are caused by knives or low-velocity handguns. Penetrating injuries in military and terrorist theatres are more often associated with high-velocity weapons, bombs and missiles, the latter can cause extensive tissue damage due to a combination of blast and shrapnel injuries.

Blunt vascular trauma is usually seen following road traffic accidents, falls, building collapses, major disasters, etc.

Type
Chapter
Information
Postgraduate Vascular Surgery
The Candidate's Guide to the FRCS
, pp. 172 - 182
Publisher: Cambridge University Press
Print publication year: 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ly, TV, Travison, TG, Castillo, RC, Bosse, MJ, MacKenzie, EJ. Group, LEAP Study. Ability of lower-extremity injury severity scores to predict functional outcome after limb salvage. J Bone Joint Surg Am 2008; 90: 1738–43.CrossRefGoogle ScholarPubMed
Fishman, EK, Horton, KM, Johnson, PT.Multidetector CT and three-dimensional CT angiography for suspected vascular trauma of the extremities. Radiographics 2008; 28: 653–65.CrossRefGoogle ScholarPubMed
Barros, D' Sa, AA, Harkin, DW, Blair, PH, Hood, JM, McIlrath, E.The Belfast approach to managing complex lower limb vascular injuries. Eur J Vasc Endovasc Surg 2006; 32: 246–56.CrossRefGoogle Scholar
Taller, J, Kamdar, JP, Greene, JA et al. Temporary vascular shunts as initial treatment of proximal extremity vascular injuries during combat operations: the new standard of care at Echelon II facilities?J Trauma 2008; 65: 595–603.CrossRefGoogle ScholarPubMed
Neschis, D, Scalea, T, Flinn, W, Griffith, B.Blunt aortic injury current concepts. New Engl J Med 2008; 359: 1708–16.CrossRefGoogle Scholar
Arthurs, ZM, Sohn, VY, Starnes, BW. Vascular trauma: endovascular management and techniques. Surg Clin N Am 2007; 87: 1179–92.CrossRefGoogle ScholarPubMed
Xenos ES, Abedi NN, Davenport DL et al. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg 2008; 48: 1343–51.CrossRefGoogle ScholarPubMed
Rathlev, NK, Medzon, R, Bracken, ME.Evaluation and management of neck trauma. Emerg Med Clin N Am 2007; 25: 679–94.CrossRefGoogle ScholarPubMed
Newton, EJ.Acute complications of extremity trauma. Emerg Med Clin N Am 2007; 25: 751–61.CrossRefGoogle ScholarPubMed
Asensio, JA, Forno, W, Roldán, G et al. Visceral vascular injuries. Surg Clin North Am 2002; 82: 1–20, xix.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×