Trauma pembuluh darah

1. Trauma Vaskular
dr. Jayarasti Kusumanegara, M.Kes, SpBTKV(K)
Divisi Bedah Toraks Kardiovaskular, Departemen Ilmu Bedah
Fakulatas Kedokteran Universitas Hasanuddin/RSUP Wahidin Sudirohusodo Makassar

2. Anatomy

4. Vascular Injury
 There has been an increase in the incidence of vascular
injury over the past four decades that has paralleled the
increase in assault with firearms, motor vehicle crashes,
and invasive medical procedures.
Caps MT, The epidemiology of vascular trauma. University of Washington, Department of Surgery, Seattle 98195-6410, USA..
Blunt Penetrating

5. Trauma Tajam vs Trauma Tumpul

6. Trauma Tajam vs Trauma
Tumpul

7. Tipe Cedera Vaskular

8. General Principles
 Always start with ABC
 Large IV pore lines
 External compression to control bleeding
 Look for hard signs of arterial injuries

9. Hard Sign and Soft Sign
Exploration
Further
Investigations

10. Algoritma Penanganan

11. Pemeriksaan Vaskular
 Cek Vital Sign
 Periksa dan bandingkan extremitas kanan dan
kiri : sianosis, pucat, perdarahan aktif.
 Raba suhu, periksa Capillary Refill Time (CRT)
 Cek Status Neurologis : kelemahan atau paralisis,
sensoris
 Cek Pulsasi Distal dan Saturasi O2

12. Ankle Brachial Index (ABI)

13. Diagnostic Tools ?
 Duplex USG
 CT angiography
 Arteriography

14. Vascular injury
“the clock starts ticking”
• Blood loss
• Progressive ischemia
• Compartment syndrome
• Tissue necrosis
Irreversible damage after 6 hours

15. Early Management
 Compression
 2 Large IV Line
 Kristaloid
 Cover wounds
 Reduce fractures/dislocations
 Splint
 Re-evaluate

16. 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
Annu Babu, Harshit Garg. Penetrating neck injury: Collaterals for another life after ligation of common
carotid artery and subclavian artery.. 2015. India

17. Annu Babu, Harshit Garg. Penetrating neck injury: Collaterals for another life after ligation of common
carotid artery and subclavian artery.. 2015. India

18. Xiao-lei Wang, MD,* Zhen-gang Xu, MD, Ping-zhang Tang, MD. Tracheo-innominate artery fistula: Diagnosis and
surgical management.. 2012. Beijing

22. Bypass Graft

23. Endovascular Management

24. Damage control
 Arteries that can be ligated with few
consequences:
- ICA ligation : high stroke rate.
- Subclavian, axillary, brachialis artery, EIA,CFA
& SFA: high risk of limb ischemia.
- SMA & IMA : gut necrosis

25. A Case
 A 18 years old male, suddenly he hit by arch by
unknown person from left side.

26. Radiology Exm.

27. Intra Operatve

29. Post Operative

30. Thank You
Jayarasti Kusumanegara
Thoracic, Cardiac, Vascular Surgeon