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Vascular trauma

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AMNCH Vascular Surgery

Peripheral arterial trauma

Health & MedicineTechnology
1 of 37
Vascular Trauma Vascular Surgery Unit AMNCH
History Welch Halsted Osler Kelly
Ambroise Par é Treatise on Surgery 1564 1552 carotid ligation
1759 - first arterial repair Rich, Leppaniemi Scand J Surg. 2002
1897 – end to end repair Rich, Leppaniemi Scand J Surg. 2002
The Problem
The Problem ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mechanism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],http://www.facs.org/trauma/publications/peripheralvasctrauma.pdf
Initial assessment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Initial assessment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Immediate treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Credit: http:// www.ota.org /
Immediate treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Credit: http:// www.ota.org /
Signs of arterial injury hard signs ,[object Object],[object Object],[object Object],[object Object],[object Object],Credit: http:// www.ota.org /
Index of suspicion soft signs ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pathology ,[object Object],[object Object],[object Object],[object Object],[object Object],Credit: http:// www.nordictraumarad.com
 
Pathophysiology Time Ischaemia Rapid resuscitation Urgent exploration Ischaemia revascularisation Tissue necrosis Reperfusion injury Compartment syn ? fasciotomy
Immediate referral ,[object Object],[object Object],[object Object],[object Object],[object Object]
Soft signs, other injuries ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Doppler ,[object Object],[object Object]
Caution …. ,[object Object],[object Object]
Primary amputation http://www.mdcalc.com/mangled-extremity-severity-score-mess-score
 
Operative management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Operative strategy - 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shunting ,[object Object]
Procedure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Repair Rich, Leppaniemi Scand J Surg. 2002
Compartment syndrome Pearse et al. BMJ 2002 2002
Location of injury Abdulkarim. The Surgeon 2008
Outcomes Rich, Leppaniemi Scand J Surg. 2002
Venous trauma ,[object Object],[object Object],[object Object],[object Object]
Other sites
Carotid trauma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Carotid trauma I cricoid 2 3
Endovascular treatment Katsanos K et al Emerg Radiol. 2009 Case series only; no convincing data
Key steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Credit: Katsanos K et al Emerg Radiol. 2009

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