Vascular Trauma

Badr Aljabri, MD, FRCSC

Associate professor and consultant
Vascular Surgery
 General Principles
 Always start with ABC
 Large IV pore lines
 External compression to control bleeding
 Look for hard signs of arterial injuries
 Try to answer !!
 Is this blunt or penetrating injury ?
 Is this Arterial or Venous injury ?
 Should I take the patient to the operating room
or do further investigations?
 Is it Hospital Vs community based vascular
injury?
 Is this Arterial or Venous injury ?
 Arterial  Pulsetile ext. bleeding
- Pulse examination  Absent distal pulses.
- Hard signs  Expanding hematoma
 Distal ischemia
 Thrill or bruit
 Is this Arterial or Venous injury ?
 Venous
- Low pressure dark blood external bleeding
- Non-expanding hematoma
- Shock is rare unless associated with arterial
injury
 Should I take the patient to the operating
room or do further investigations?
 Any patients with these following signs should
not wait !!!!
- External bleeding
- Expanding hematoma with shock
- Limb ischemia
 Hospital based trauma

 Venous : Central venous access hematoma

Guide wire dislodgment

 Arterial : catheterization
- Psudoaneurysm
- Arterial dissection & Thrombosis
- AV Fistula formation
- Distal Embolization
 Psudoaneurysm
 walled off extra- luminal circulation of the blood
as a result of arterial wall disruption.
 Psudoaneurysm
 Conservative
 U/S guided compression
 U/S guided thrombin injection
 Surgery
 Psudoaneurysm
 Indications for surgical intervention:
1) Evidence of ongoing bleeding
2) Associated limb ischemia
3) Nerve compression
4) Need for aggressive anticoagulation
5) Threatened skin viability
6) Psudoaneurysm surrounded by large hematoma
7) Expanding
 Community based trauma

 Penetrating injury : most common cause

 Blunt trauma: associated with orthopedic

injuries.
 Extremity vascular injury

 10% following penetrating ext. injury

 1% following blunt ext. injury ( 25-75% of

Popliteal are due to blunt trauma)
 What should you do in OR?

 Keep in mind your inflow and outflow arteries

 Always think about your vascular conduit
 Be prepared to do on-table angiography
 Do not hesitate to call for help
 What should you do in OR?

 Always establish good exposure

 Establish proximal then distal arterial control
 Use a shunt if the bones need to be fixed first to buy
you some time
 Use local heparin flush
 Make your arterial repair tension-free
 Use autogenous vein
 Repair concomitant venous injury if patient is stable
 What should you do in OR?

 Make your threshold low for

“Fasciotomy”
Vein patch angioplasty
Tension-free primary
repair
Interposition autogenous
vein graft
 Damage control
 Arteries that can be ligated with few
consequences:
- The common and external carotid, subclavian,
axillary , internal iliac arteries & Celiac axis.
- ICA ligation : 10-20% stroke rate.
- EIA,CFA & SFA: high risk of limb ischemia.
- SMA & IMA : gut necrosis
 Damage control

 Almost all veins including the IVC can be

ligated when necessary
 Blunt Thoracic Aortic Trauma
 Deceleration injury.
 Multiple trauma victims
 It is lethal if not recognize and treated promptly
 Usually distal to left subclavian artery.
 Neck Trauma
 Most commonly penetrating type.
 Associated vascular injury in > 30%
Thank You
Badr Aljabri, MD, FRCSC
Assistant professor and consultant Vascular
Surgery