for surgery ug n pg....prepared by dr.narendra pg GEN. SURGERY NRI MEDICAL COLLEGE GUNTUR

1. G.NARENDRA
ARTERIAL INJURIES

2. HOW TO IDENTIFY
 Bright pulsatile hemorrhage
 Tense hematoma developed rapidly
 Signs of distal ischemia

3. Basic rule
 Always assume that there is involvement of major
artery in injury

4. How to control it
 Controlled by local pressure on wound
 Compression of artery over bony prominence
 Never use a torniquet-
 A torniquet controls an artery affectively but
causes venous stasis
 If at all torniquet used...use with less tension & for
less time

5.  Intra operatively
 Artery to be controlled just proximal to site of
injury
 Never use sharp instruments
 Never ligate if its a major vessel, instead clamp &
wait
 Torniquet to be released as early as possible
 Other way- use of fogarty catheter

7. Repair of damaged artery
 Ligation is – a last resort
 Clean cuts / punctures – reapaired directly
 Systemic i.v heparin 5000 u to be given as soon
as bleeding controlled
 50 – 100 ml heparin – saline to be instilled in
distal artery through wound

8. How to stitch
 Sutured with 5-0 / 6-0 prolene
 Silk only in emergency if other materials not
available
 All coats of arterial wall are to be included in
stitch
 Intimal tears to be incorporated

9. check
 Just before final closure, proximal & distal clamps to
be released to ensure flow is present
 If any small clots- flushed out of artery
 Downflow should be audible & visible
 If flow is poor – pass a fogarty catheter
 Still minor bleed- gentle pressure with swab for few
minutes
 Brisk bleeding- interrupted sutures

10. If there is loss of arterial wall
 Vein patch graft
 Vein segment removed , opened out to form a
patch
 Precaution – see no valves are present
 DACRON graft

11.  Extensive damage to artery – direct closure
impossible
 Severe contusion of arterial wall
 Artery replaced by autogenous vein
 eg- saphenous vein excised & reversed, so that
its valves doesnt prevent flow

13. What to repair first in injury
 BONE
 VEIN
 ARTERY
 NERVE & TENDON
 Fasciotomy should be considered in all cases

14. Closed arterial injuries
 No external injury-
 But no pulse distally
 Cause- compression of artery or
 intimal injury with intact media & adventia
 Rx- explore . Dissect from surroundaries
 still no pulse- resection & venous grafting

15. Accidental intra arterial injection
 Usually painless
 Except with some drugs like thiopentone
 Mcly involved is superficial ulnar artery
 Preventive measures
 Use lower dilutions of drug
 Use veins on dorsal side

16.  Leave the needle insitu
 Give heparin infusion – to prevent thrombosis
 Followed by systemic heparinization

17. Complications of arterial surgery
 HAEMORRAGE-
 Early – within 12 hrs- suture has given away
 Rx – re exploration
 Late- after 2 days – mostly result of sepsisrx-
ligation of artery or a by pass surgery or
amputation

18.  Sepsis – cellulitis
 Renal failure- may be due to hypotension /
dehydration
 Rx- iv fluids 1 litre more than requirement with iv
furosemide
 If not improved - hemodialysis

19. Classification of haemorrhage
 According to type of vessel
 Arterial
 Venous
 Capillary

20.  Arterial- bright red , spurting, pulsatile
 Venous – dark red, steady & copious
 Capillary- bright red & rapid ooze

21.  According to site of bleed
 External
 Internal- hemoperitoneum, hemothorax
 Interno external hemorrhage-
 hemorrage into gut manifesting as malena
 Hemorrage into kidney manifesting as hematuria

22.  According to interval from injury
 Primary – immediately after injury or operation
 Reactionary hemorrhage- occurs within 24 hrs of
injury
 Slippage of ligature
 Recovery from hypotension
 Violent attacks of cough/vomit increasing intravascular
pressure
 Secondary – 7 – 14 days after injury
 Infection & sloughing of part of vessel

23.  According to method of treatment
 Surgical hemorrhage-
 Non surgical- hemorrhage corrected by correction
of coagulation defects

24. THE END