Damage control of peripheral vascular trauma - Don’t be afraid of axillary or popliteal fosses

Abstract

Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient’s life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed postoperatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. All permanent or temporary vascular procedures should be followed by a definitive repair within the first 8 hours. An early diagnosis and opportune intervention are fundamental to preserve the function and perfusion of the extremity.

Iatrogenic Vascular Injuries: A Review

“…Vascular damage may have occurred in as much as 12% of recent military operations in Iraq and Afghanistan. In comparison to earlier South East Asian campaigns, this represents a fivefold increase [11]. Although it varies greatly by region, the occurrence of vascular trauma in civilians is substantially lower.…”

“…The prevalence of vascular trauma is still largely unclear despite the fact that torso injuries are more frequent than in military settings in the majority of countries due to the lack of extensive registry data. Vascular trauma experts face populationspecific difficulties due to vascular injuries in patients' juvenile and geriatric cohorts [11]. Worldwide, earlier studies estimated yearly incidence in civilians ranges from 0.9 to 2.3 per 100,000 [12].…”

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“…Las lesiones de vía aérea que comprometen a la laringe y/o a la tráquea son poco frecuentes, corresponden aproximadamente a 1 cada 250.000 consultas en urgencia 30 , entre el 0,1 y el 10 % de los traumas de cuello presentarán una lesión de laringe o tráquea que, en el 66,9% de los casos estará asociada a otras lesiones. 30 Se presentan en forma aislada, con mayor frecuencia, como consecuencia de trauma cervical cerrado. 11,25 La mortalidad de las lesiones de vía aérea, en el sitio del accidente, se estima en un 82%.…”

“…11,25 La mortalidad de las lesiones de vía aérea, en el sitio del accidente, se estima en un 82%. 30 La prioridad siempre será mantener permeable la vía aérea. La mortalidad por trauma de laringe está entre el 1,6 y el 11 % y por trauma de tráquea en 13,6 % para trauma abierto y en 25 % para trauma contuso.…”

“…La palpación puede evidenciar deformación del contorno normal de laringe y/o tráquea y crepitación. 11,16,21,30 Las lesiones de laringe consecuencia del trauma se clasifican en cinco grados, de gravedad creciente, para cada grado de lesión está establecido un tratamiento, como veremos más adelante (ver cuadro 1). No hay una clasificación similar para las lesiones de la tráquea consecuencia del trauma.…”