This document discusses vascular injuries, covering their mechanisms, recognition, and management. It begins with the objectives of understanding trauma management principles, vascular anatomy, and mechanisms of injury. For management, the document outlines the ABCDE primary survey, resuscitation to control bleeding and protect airways, and secondary survey. It then details the specific mechanisms of penetrating, blunt, blast, and iatrogenic vascular injuries. The document concludes by discussing principles of vascular repairs, options for peripheral repairs, and potential complications.

1. Vascular Injuries
Mohammad Shihata
02/01/2014

2. Objectives
✤ Principles of trauma management
✤ Vascular zones of the body
✤ Mechanisms of vascular trauma
✤ Recognition of vascular injuries
✤ Management of Vascular injuries

4. My ATLS App for smart phones and tablets

5. A, B, C, D, E
Primary survey
–A Airway maintenance with cervical spine
protection
–B Breathing and ventilation
–C Circulation with hemorrhage control
–D Disability : Neurological status
–E Exposure/Environmental control : completely
undress the patient,but prevent hypothermia

6. Resuscitation
✤ Control Bleeding
✤ Protect and maintain airway
✤ Two large bore IVs for rapid infusion

7. Secondary survey
Secondary survey does not begin until
the primary survey (ABCDEs) is
completed, resuscitative efforts are
well established, and the patient is
demonstrating normalization of vital
functions.

8. Secondary Survey
– Total patient evaluation
• history : AMPLE
• physical examination
– Complete neurologic examination
– Head and skull
– Maxillofacial
– Neck
– Chest
– Abdomen
– Perineum/rectum/vagina
– Musculoskeletal
– Tubes and fingers in every orifice

9. “He Who wants to be a surgeon, should
go to war”
Hippocrates (460 - 377 BC)

10. Mechanisms of Vascular Injuries
✤ Penetrating Trauma
✤ Blunt Trauma
✤ Blast injuries
✤ Iatrogenic Injuries

11. Ask yourself
 IIss tthhiiss bblluunntt oorr ppeenneettrraattiinngg iinnjjuurryy ??
 IIss tthhiiss AArrtteerriiaall oorr VVeennoouuss iinnjjuurryy ??
 SShhoouulldd II ttaakkee tthhee ppaattiieenntt ttoo tthhee ooppeerraattiinngg rroooomm oorr ddoo ffuurrtthheerr
iinnvveessttiiggaattiioonnss??

12. Arterial injuries

13. Venous Injuries
✤ Low pressure
✤ Dark blood
✤ Non-expanding hematoma

14. Upper Extremity

15. Lower Extremity

18. Neck Vessels

20. Thoracic Aorta

21. Aortic Arch Tear

23. Aortic Arch Transection
✤ Common in deceleration ( blunt ) type injuries
✤ Most common site is the ligamentum attachment ( isthmus)
✤ Free rupture is incompatible with life
✤ Contained rupture is associated with increased risk of free rupture
✤ Usually associated with other life threatening injuries

24. Principles of Vascular Repairs
✤ Know your anatomy ( Course, Feeding vessel, Run-off)
✤ Adequate Exposure
✤ Proximal and distal control
✤ Tension free repair
✤ Adjuncts (intra op tPA, Imaging, .....)
✤ Assess the need for fasciotomy

25. Options for peripheral vascular
repair
No Transection
✤ Primary Repair
✤ Patch Angioplasty
✤ Endovascular treatment
Complete Transection
✤ Primary end to end anastomosis
✤ Interposition graft
✤ Bypass

26. Patch angioplasty

27. End to End anastomosis

29. Complications of Vascular Injuries
✤ Life threatening bleeding
✤ End organ ischemia
✤ Associated injuries
✤ Sensory / Motor Loss
✤ AV fistula
✤ Pseudoaneurysm

30. Thank You