الفهرس 
Mechanisms and Incidences of Traumatic Vascular InjuriesOnly 14 pages are availabe for public view
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Abstract
• Vascular trauma can result from either blunt or penetrating injury
• Pattern of injury differs according to the mechanism of injury
• Blunt vascular trauma is associated with an increased amputation rate
• Results from blunt injury being associated with significant fractures and tissue loss
• The diagnosis of blunt vascular trauma is often delayed .
Types of vascular injury
• Contusion
• Puncture
• Laceration
• Transection
Clinical features (Rowe, et al;2002)
• Depends on site, mechanism and extent of injury
• Signs classically divided into ’hard’ and ’soft’ sign
Hard signs of vascular injury
• Absent pulses
• Bruit or palpable thrill
• Active haemorrhage
• Expanding haematoma
• Distal ischaemia
Soft signs of vascular injury
• Haematoma
• History of haemorrhage at seen of accident
• Unexplained hypotension
• Peripheral nerve deficit
Investigation
• Hard signs often require urgent surgical exploration without prior investigation
• Arteriography should be considered:
o To confirm extent of injury in stable patient with equivocal signs
o To exclude injury in patient without hard signs but strong suspicion of vascular injury
The role of doppler ultrasound in vascular trauma remains to be defined
Management
• Often requires a multidisciplinary approach with orthopaedic and plastic surgeons
• Aims of surgery are to:
o Control life-threatening haemorrhage
o Prevent limb ischaemia
• If surgery is delayed more than 6 hours revascularisation is unlikely to be successful
• The use of arterial shunts is controversial
May reduce ischaemic time and allow early fixation of fractures
Vascular repair
• Usually performed after gaining proximal control and wound debridement
• Options include :
o Simple suture of puncture hole or laceration
o Vein patch angioplasty
o Resection and end-to-end anastomosis
o Interpositional graft
• Contralateral saphenous vein is the ideal interpositional graft
Prosthetic graft material may be used if poor vein or bilateral limb trauma.
The continued advances in imaging and stent -graft (SG) technology have considerably expanded the indications for endovascular approach in vascular trauma, with the potential advantage of avoiding part of the challenging problemsof conventional repair.