Vascular Injuries and Principles of ManagementVascular Surgery Workshop 2018 Joel Arudchelvam,MBBS (Col), MD (Sur), MRCS (Eng),Consultant Vascular and Transplant Surgeon Teaching Hospital Anuradhapura. Causes, Mechanism of injury, Arterial Level injuries, Signs of vessel injury -Hard signs,Soft sign, Principles of management

1. Vascular Injuries
and
Principles of Management
Vascular Surgery Workshop 2018
Joel Arudchelvam
MBBS (Col), MD (Sur), MRCS (Eng)
Consultant Vascular and Transplant Surgeon
Teaching Hospital Anuradhapura.

2. Vascular Trauma /Injury
• Injuries to
– Arteries
– Veins
• Anatomical regions
– Extremity – limbs
– Abdomen and pelvis
– Thorax
– Head and neck

3. Causes
• Road Traffic Accidents – 38.5%
• Trap Gun – 7.5%
• Home Accidents - 7.5%
• Cuts and Stabs
• Iatrogenic - 46.1%
Mechanism of injury
• Sharp / penetrating
• Blunt
Anuradhapura – 2015 - 2016

4. At Arterial Level

5. Vascular Trauma
Signs of vessel injury
• Hard signs
• Soft sign
Hard signs
– Active bleeding
– Signs of distal ischaemia
– Expanding hematoma
– Thrills, Bruits

6. Signs of a vessel injury
• Soft signs
– Hematoma
– Injury close to a known neurovascular bundle
– Reduced pulse
• In limbs;
– Paresis and Paresthesia - Viability threatened
– Anaethesia and paralysis - Not viable.

7. Investigations
– CT angiography

8. CT Angiography

9. 3D Reconstruction

10. Principles of management
• Resuscitate
• Assess viability and extent of injury
• Repair as soon as possible
– + / - EF
– +/ - fasciotomy
• Post intervention monitoring
• Rehabilitation

11. Surgical Repair
• General Anesthesia
• Clean the Entire Limb
• Prepare Opposite Thigh – For Vein Graft

12. Surgical Repair (Cont..)
• Control of proximal and distal ends and trimming
• Thrombectomy
• Interposition graft / Direct approximation
– Unit experience – 88.2% RSVG
• Prosthesis
– Lower patency
– Infection

16. Surgical Repair (Cont..)
• Wound debridement
• Control of proximal and distal ends and trimming
• Thrombectomy
• Interposition Graft / Direct Approximation
– Unit Experience – 88.2% RSVG
• Prosthesis
– Lower Patency
– Infection

17. RSVG

18. Combined Vascular and Skeletal
Trauma
– Revascularization / Fixation (External Fixator – EF)
• Bone fixation first if limb is not threatened
• Apply EF antero - laterally
• Revascularisation first if limb is threatened

19. Primary Amputation
• Extensive injuries – “Mangled Limb”
• No need to transfer – Discuss / Photo

20. Principles of management
• Resuscitate
• Assess viability and extent of injury
• Repair as soon as possible
– + / - Fasciotomy
– + / - EF
• Post Intervention Monitoring
• Rehabilitation

21. Thank You