This document discusses vascular injuries, their causes, signs, investigations, and principles of management. It focuses on surgical repair techniques including preparing the limb, assessing and trimming the injured vessel, thrombectomy, and using a reverse saphenous vein graft or direct approximation when possible. It also addresses venous injuries, combined vascular and skeletal trauma, and the role of primary amputation in extensive crush injuries. The overall aim is to resuscitate the patient, repair the injury as soon as possible with or without fasciotomy or external fixation, provide post-operative monitoring, and enable rehabilitation.

1. Vascular Injuries
and
Principles of Management
Anastomosis techniques Handson
workshop, NHSL
2021
Joel Arudchelvam
MBBS (Col), MD (Sur), MRCS (Eng)
Consultant Vascular and Transplant Surgeon .

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. Mechanism of disruption of flow 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
• Repair is done only in haemodynamically stable patient
• General Anesthesia
• Clean the Entire Limb
• Prepare Opposite Thigh – For Vein Graft

12. Surgical Repair (Cont..)
• Assess the extent of injury
• Fasciotomy
• Longitudinal incisions
• Control of proximal and
distal ends
• Enter the haematoma and a
ssess the injured vessel
ends

13. Assess the injured vessel ends

14. Surgical Repair (Cont..)
• Trim the injured vessel segment
• Thrombectomy

15. • Assess the need for graft

16. Surgical Repair (Cont..)
RSVG
• Interposition Graft / Direct Approximation
Unit Experience – 88.2% RSVG
Prosthesis
Lower Patency
Infection

17. Venous injuries
• injuries to the popliteal vein and proximal vei
ns, axillary vein and proximal veins need to be
repaired.
• Conduits
– Native - preferred
– prosthesis

18. Venous injuries
• Native vein
– Need to reconstruct to match the size
• Panelled
• Spiral
– Heparinise

19. 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

20. Primary Amputation
• Extensive crush injuries and soft
tissue damage – “mangled limb”
• No need to transfer – discuss / photo

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

22. Thank You

23. Surgical Repair (Cont..)
• Longitudinal incisions
• Control of proximal and distal ends
• Enter the haematoma and assess the injured vessel ends
• Thrombectomy
• Interposition graft / Direct approximation
– Unit experience – 88.2% RSVG
• Prosthesis
– lower patency
– infection