Vascular Injuries: Trends in Management

Abstract

Vascular injury presents a great challenge to the emergency resident because these injuries require urgent intervention to prevent loss of life or limb. Sometimes serious vascular injury presents with only subtle or occult signs or symptoms. The patient may present weeks or months after initial injury with symptoms of vascular insufficiency, embolization, pseudoaneurysm, arteriovenous fistula etc. Although the majority of vascular injuries are caused by penetrating trauma from gunshot wounds, stabbing or blast injury, the possibility of vascular injury needs to be considered in patients presenting with displaced long bone fractures, crush injury, prolonged immobilization in a fixed position by tight casts or bandages and various invasive procedures. iatrogenic vascular injuries constitute about 10% of cases in most series; however the incidence is an increasing trend because more endovascular procedures such as angioplasty and cardiac catheterization are being performed routinely.Civilian trauma is more frequently seen in young males. However, it can occur at any age due to road accidents, firearms, bomb blasts and diagnostic procedures. Most of the time, civilian trauma causes less tissue damage. There is an epidemic of vascular injuries in Kashmir valley because of problems in law and order in the past two decades. This review deals with the topic in detail.

Vascular Trauma Registry Analysis in Sulaimani Province of Southern Kurdistan

“…In our study, 10.6% of the patients developed various complications (amputation, fistulas and death). Limb ischemia occurred after revascularization in one patient (2.1%) which is comparable with other studies [14].…”

“…Sometimes, early amputation can be the best option for some patients that saves their lives. Amputation rate depends on many factors including the severity of limb injury, mechanism of injury, ischemia time, and presence of associated injuries [14]. In our study 3 patients (6.4%) underwent amputation as a result of severe infection causing anastomotic disruption and impending septicaemia.…”

“…Venous repair remains a controversial issue in patients with vascular injuries [18]. However, most would agree that venous repair by means, other than simple lateral suturing and end-to-end anastomosis, is a time consuming process with uncertain benefits especially in multiply injured patients [14]. In our series, 2 out of 27 patients with venous injury underwent simple lateral repair, others underwent ligation.…”

“…It is generally agreed that autologous vein grafts are the best due to durability, resistance to infection, and ability to draw nutrient flow from the surrounding viable tissues [9] [14]. Depending on these well known facts no prosthetic graft was used in our series while autologous vein grafts were used in 3 cases (6.4%).…”

Subfailure Overstretch Injury Leads to Reversible Functional Impairment and Purinergic P2X7 Receptor Activation in Intact Vascular Tissue

“…In particular, endoscopic harvest of human saphenous vein (HSV) is associated with stretch injury and impacts the outcome of coronary artery bypass procedures (Cook et al, 2004 ; Rousou et al, 2009 ; Kiani et al, 2012 ; Andreasen et al, 2015 ). Vascular stretch injury is associated with thrombosis, spasm, intimal injury, and hyperplastic growth, and subsequently reduced blood flow to target organs (Van Belle et al, 1998 ; Lee et al, 2010 ; Wani et al, 2012 ).…”