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Published on: January 18, 2018
Management of vascular injuries on ICU patients: KZN experience
V C Ntola1, T C Hardcastle2, N M Nkwanyana3
1Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
Insights
Vascular trauma management strategies vary by vessel type. Arterial injuries often utilize open repair or endovascular intervention, while venous injuries predominantly undergo open ligation.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Emergency Medicine
Background:
- Vascular injury management is critical for preventing death and amputation.
- Modern approaches have shifted from ligation to primary repair, significantly reducing amputation rates.
Purpose of the Study:
- To analyze management strategies for vascular trauma in polytrauma patients.
- To compare open versus endovascular interventions for arterial and venous injuries.
Main Methods:
- Retrospective and prospective data collection from a trauma registry (2013-2022).
- Analysis of 154 arterial and 39 venous injuries in ICU-requiring polytrauma patients.
- Data included injury type, mechanism, management, and outcomes.
Main Results:
- Arterial injuries: 50% open repair, 23% endovascular intervention.
- Venous injuries: 51% open ligation, 31% non-surgical management.
- Aortic injuries showed high endovascular use (83% TEVAR).
Conclusions:
- Management choice for vascular trauma depends on the specific blood vessel injured.
- Open ligation remains the primary treatment for most venous injuries in this cohort.
Background:
Vascular injury management remains an extremely challenging task. The fundamental principles of management are bleeding arrest and flow restoration, to avoid death and amputation. With advances in medicine, there has been a shift from ligation to primary repair which has resulted in a fall in amputation rate from 50 % in World War II to less than 2 % in civilian injuries.
Method:
A retrospective cross-sectional study was conducted on ICU requiring polytrauma patients with vascular trauma admitted between January 2013 and December 2021. Additional data were collected prospectively from January 2022 to December 2022. All data was from an ethics approved Trauma Registry. The injury was either confirmed by imaging or via exploration. The pre-designed data proforma acquired the following variables: age, mechanism of injury, injured vessel, associated injury, management of the vessel, and management of the associated injury. The data were analysed using Stata version 17 (StataCorp, College Station TX). Frequencies and percentages were calculated to summarise numerical data An ethical clearance was granted by the University of KwaZulu-Natal BREC (BREC 0004353/2022) and the KZN Department of Health. All data were de-identified in the data collection sheet.
Results:
There were 154 arterial injuries and 39 venous injuries. The majority, 77 (50 %) of arterial injuries were managed via open strategies, and 36 (23 %) were managed via endovascular intervention. The majority, 20 (51 %) of venous injuries underwent open ligation, and 12 (31 %) were managed non-surgically. The highest number of endovascular interventions was observed in aortic injuries. For a total of 25 aortic injuries, 22 (83 %) were managed endovascular (TEVAR) and 2 (8 %) were managed non-operatively.
Conclusion:
The choice between the endovascular and open approach depends on the injured blood vessel. The majority of venous injuries were treated with open ligation in this cohort.
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