2. INTRODUCTION
Vascular injuries remain among the most challenging entities encountered
in the setting of trauma care.
Improvements in diagnostic capabilities, resuscitation approaches,
vascular techniques, and prosthetic device options have afforded
considerable advancement in the care of these patients.
Despite these advances, however, uncontrolled hemorrhage due to major
vascular injury remains one of the most common causes of death after
trauma.
Successful management of vascular injury requires the timely diagnosis
and control of bleeding sources.
Pedro G.R. Teixeira, MDa , Joe DuBose, MDb. 2017. Surgical Management of Vascular Trauma. Surg Clin N Am 97 (2017) 1133–1155. a Department of Surgery and Perioperative Care, University Medical Center Brackenridge, Dell
Medical School, University of Texas at Austin,
3. REPAIR VASCULAR
DIAGNOSTIC IMAGING
Sign of vascular injury
INITIAL EVALUATION
As a general principle, the
presence of a hard sign of
vascular
injury warrants immediate
operation for exploration
and earliest possible
control of vascular
hemorrhage.
DEFINITIF REPAIR
Primary Repair,
Autogenous versus
Prosthetic Conduit,
Prosthetic Conduits,
Endovascular Stent Grafts
EMERGENT MANGAEMENT
Damage control surgery
INTRAOPERATIVE
ANTICOAGULATION
Heparinization
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Pedro G.R. Teixeira, MDa , Joe DuBose, MDb. 2017. Surgical Management of Vascular Trauma. Surg Clin N Am 97 (2017) 1133–1155. a Department of Surgery and Perioperative Care, University Medical Center Brackenridge, Dell
Medical School, University of Texas at Austin,
4. SIGN OF VASCULAR INJURY
Pedro G.R. Teixeira, MDa , Joe DuBose, MDb. 2017. Surgical Management of Vascular Trauma. Surg Clin N Am 97 (2017) 1133–1155. a Department of Surgery and Perioperative Care, University Medical Center Brackenridge, Dell
Medical School, University of Texas at Austin,
6. Various hemostatic agents are routinely used to achieve hemostasis, decrease the operation time, and
fortify anastomotic sites. Despite their widespread use, few studies have elucidated the efficacy, safety,
and relative cost of the individual agents. Hemostatic agents can be classified into four main groups:
absorbable agents, biologically active agents, dual agents (absorbable and biologically active
constituents), and adhesives (synthetic and biologic; Table I).
Jonathan K. Allotey, MS, Alexander H. King, MS, Norman H. Kumins, MD, Virginia L. Wong, MD, Karem C. Harth, MD, Jae S. Cho, MD, and Vikram S. Kashyap, MD, Cleveland, Ohio. Systematic review of
hemostatic agents used in vascular surgery.Journal of Vascular Surgery 2021
7. Jonathan K. Allotey, MS, Alexander H. King, MS, Norman H. Kumins, MD, Virginia L. Wong, MD, Karem C. Harth, MD, Jae S. Cho, MD, and Vikram S. Kashyap, MD, Cleveland, Ohio. Systematic review of
hemostatic agents used in vascular surgery.Journal of Vascular Surgery 2021
15. HEPARINIZATION
The use of this adjunct has been shown to
improve outcomes in select vascular injuries,
including carotid and popliteal artery injuries
The decision to use systemic heparinization
does, however, require careful consideration
and multidisciplinary discussion with the
trauma team.
Appropriate use requires
patient stability, the absence of
traumatic brain injury, or neurologic
deficit and minimal associated blood
loss from concomitant solid organ and
musculoskeletal injuries
When heparin is contraindicated, the
authors recommend liberal instillation
of
heparinized saline into the proximal
and distal segments of the injured
vessel at regular
intervals during repair.
The use of systemic heparinization is
ubiquitous to elective vascular surgery and
may be beneficial for the operative
management of vascular injuries after vascular
control
and during reconstruction.
Pedro G.R. Teixeira, MDa , Joe DuBose, MDb. 2017. Surgical Management of Vascular Trauma. Surg Clin N Am 97 (2017) 1133–1155. a Department of Surgery and Perioperative Care, University Medical Center Brackenridge, Dell
Medical School, University of Texas at Austin,
16. 01
02
03
a “polypharmaceutical” is one of the most salient anticoagulants used
in clinic, with approved anti-inflammatory, complement activation
inhibitory, anti-cancer, anti-viral, and angiogenesis regulatory effects.
Heparin also binds to the cell surface receptors containing sugar
recognition domains and mediates interaction with extra cellular matrix
proteins and activated platelets
Heparinization of biomaterials can help cell attachment, proliferation
and differentiation through preventing nonspecific protein adsorption
and localizing growth factors.
Heparin, a relatively large linear anionic polyelectrolyte having an
average of −75 net charge per chain,
is a member of glycosaminoglycans which is composed of about 20
disaccharide units
Saba Aslania,b , Mahboubeh Kabiria,⁎ , Simzar HosseinZadehc , Hana Hanaee-Ahvazd , Elham Sadat Taherzadehd , Masoud Soleimani. The applications of heparin in vascular tissue engineering. Microvascular
Research 131 (2020) 10402017
17. Saba Aslania,b , Mahboubeh Kabiria,⁎ , Simzar HosseinZadehc , Hana Hanaee-Ahvazd , Elham Sadat Taherzadehd , Masoud Soleimani. The applications of heparin in vascular tissue engineering. Microvascular
Research 131 (2020) 10402017
18. POSTOPERATIVE EVALUATION
An additional question postoperatively remains
the optimal role of postintervention
anticoagulation or antiplatelet therapy.
Physical examination
Duplex examination or angiogram to confirm
patency of repair and the absence of a missed
additional injury.
After any vascular intervention or repair,
restoration of perfusion should be
confirmed appropriately.
Pedro G.R. Teixeira, MDa , Joe DuBose, MDb. 2017. Surgical Management of Vascular Trauma. Surg Clin N Am 97 (2017) 1133–1155. a Department of Surgery and Perioperative Care, University Medical Center Brackenridge, Dell
Medical School, University of Texas at Austin,
Kesimpulan
1. Semua agen hemostatik mencapai hemostasis pada tingkat yang jauh lebih baik daripada kompresi manual. 2. Agen hemostatik yang aktif secara biologis seperti fibrin sealant memiliki waktu yang lebih singkat untuk hemostasis dibandingkan bahan yang mampu menyerap seperti selulosa regenerasi teroksidasi. Gambar. PRISMA (Item Pelaporan Pilihan untuk Sistematis ulasan dan Meta-Analisis) diagram alir pemilihan studi. Jurnal Bedah Vaskular Allotey dkk 2195 Jilid 73, Nomor 6 3. Perekat sintetis seperti CoSeal yang berpolimerisasi menjadi membentuk hidrogel yang kuat memiliki waktu yang jauh lebih singkat untuk hemostasis dibandingkan dengan aktif secara biologis agen seperti TSG. 4. Agen hemostatik dengan bahan sapi atau babi membawa risiko menyebabkan reaksi anafilaksis intraoperatif atau pascaoperasi pada beberapa pasien. Fibrin sealant yang kekurangan faktor penstabil aprotinin dan fibrin XIII tidak akan mengikat dengan kuat pada cangkokan ePTFE. BioGlue punya ditemukan menyebabkan sejumlah komplikasi, termasuk stenosis vena cava dan emboli koroner. 5. Agen yang paling mahal adalah biologis dan perekat sintetis. Agen ganda yang mengandung keduanya trombin dan gelatin dengan harga sedang. Bahan yang dapat diserap terbuat dari selulosa, dapat diserap matriks, atau konstituen polisakarida mikropori termasuk agen yang paling murah.
