Vascular trauma

An arterial injury causes either major haemorrhage with hypovolaemia and shock or ischaemia in the distribution of the damaged vessel. Initial management consists of establishment of an airway and haemodynamic stabilisation. If there is persisting hypotension because of continuing bleeding, further resuscitation is carried out in the operating room. A rapid systematic examination is performed with a thorough evaluation of motor and sensory function, as vascular injuries are often accompanied by nerve injuries, which should be well defined prior to any attempts at vascular repair. Arteriography, if available promptly, is useful in stable patients. It allows assessment of the extent of injury and of distal vessels and may prevent unnecessary exploration of neck and extremity injuries. However, it should not delay the vascular repair beyond six hours from the time of injury. It is useful if the site of injury is unclear, the trajectory of a missile is unknown or there are multiple pellet injuries but it is unnecessary if there is an obvious vascular injury. It is helpful to have facilities available for intra-operative arteriography. Repair of arterial injury is performed whenever possible. Prolonged ischaemia, beyond six to eight hours, causes irreversible nerve damage and will lead to an unsatisfactory result, even if re-vascularisation is successful. The principle of proximal and distal control and adequate debridement of damaged artery and surrounding tissue must be adhered to. The type of repair depends on the nature and extent of the arterial injury and includes lateral repair, end-to-end anastomosis and vein graft interposition.(ABSTRACT TRUNCATED AT 250 WORDS)