الفهرس | Only 14 pages are availabe for public view |
Abstract • Vascular trauma can result from either blunt or penetrating injury • Pattern of injury differs according to the mechanism of injury • Blunt vascular trauma is associated with an increased amputation rate • Results from blunt injury being associated with significant fractures and tissue loss • The diagnosis of blunt vascular trauma is often delayed . Types of vascular injury • Contusion • Puncture • Laceration • Transection Clinical features (Rowe, et al;2002) • Depends on site, mechanism and extent of injury • Signs classically divided into ’hard’ and ’soft’ sign Hard signs of vascular injury • Absent pulses • Bruit or palpable thrill • Active haemorrhage • Expanding haematoma • Distal ischaemia Soft signs of vascular injury • Haematoma • History of haemorrhage at seen of accident • Unexplained hypotension • Peripheral nerve deficit Investigation • Hard signs often require urgent surgical exploration without prior investigation • Arteriography should be considered: o To confirm extent of injury in stable patient with equivocal signs o To exclude injury in patient without hard signs but strong suspicion of vascular injury The role of doppler ultrasound in vascular trauma remains to be defined Management • Often requires a multidisciplinary approach with orthopaedic and plastic surgeons • Aims of surgery are to: o Control life-threatening haemorrhage o Prevent limb ischaemia • If surgery is delayed more than 6 hours revascularisation is unlikely to be successful • The use of arterial shunts is controversial May reduce ischaemic time and allow early fixation of fractures Vascular repair • Usually performed after gaining proximal control and wound debridement • Options include : o Simple suture of puncture hole or laceration o Vein patch angioplasty o Resection and end-to-end anastomosis o Interpositional graft • Contralateral saphenous vein is the ideal interpositional graft Prosthetic graft material may be used if poor vein or bilateral limb trauma. The continued advances in imaging and stent -graft (SG) technology have considerably expanded the indications for endovascular approach in vascular trauma, with the potential advantage of avoiding part of the challenging problemsof conventional repair. |