1. Associate professor and consultant Vascular Surgery
Vascular Trauma
Badr Aljabri, MD, FRCSC
Associate professor and consultant Vascular Surgery

2. General Principles Always start with ABC Large IV pore lines
External compression to control bleeding
Look for hard signs of arterial injuries

3. Try to answer !! Is this blunt or penetrating injury ?
Is this Arterial or Venous injury ?
Should I take the patient to the operating room or do further investigations?
Is it Hospital Vs community based vascular injury?

4. Is this Arterial or Venous injury ?
Pulse examination
Hard signs
Pulsetile ext. bleeding
Absent distal pulses.
Expanding hematoma
Distal ischemia
Thrill or bruit

5. Is this Arterial or Venous injury ?
Low pressure dark blood external bleeding
Non-expanding hematoma
Shock is rare unless associated with arterial injury

6. Should I take the patient to the operating room or do further investigations?
Any patients with these following signs should not wait !!!!
External bleeding
Expanding hematoma with shock
Limb ischemia

7. Hospital based trauma Venous : Central venous access hematoma
Guide wire dislodgment
Arterial : catheterization
- Psudoaneurysm
- Arterial dissection & Thrombosis
- AV Fistula formation
- Distal Embolization

8. Psudoaneurysm
walled off extra- luminal circulation of the blood as a result of arterial wall disruption.

10. Psudoaneurysm Conservative U/S guided compression
U/S guided thrombin injection
Surgery

11. Psudoaneurysm Indications for surgical intervention:
1) Evidence of ongoing bleeding
2) Associated limb ischemia
3) Nerve compression
4) Need for aggressive anticoagulation
5) Threatened skin viability
6) Psudoaneurysm surrounded by large hematoma
7) Expanding

13. Community based trauma
Penetrating injury : most common cause
Blunt trauma: associated with orthopedic injuries.

14. Extremity vascular injury
10% following penetrating ext. injury
1% following blunt ext. injury ( 25-75% of Popliteal are due to blunt trauma)

18. What should you do in OR?
Keep in mind your inflow and outflow arteries
Always think about your vascular conduit
Be prepared to do on-table angiography
Do not hesitate to call for help

19. What should you do in OR? Always establish good exposure
Establish proximal then distal arterial control
Use a shunt if the bones need to be fixed first to buy you some time
Use local heparin flush
Make your arterial repair tension-free
Use autogenous vein
Repair concomitant venous injury if patient is stable

20. What should you do in OR?
Make your threshold low for
“Fasciotomy”

23. Vein patch angioplasty

24. Tension-free primary repair

25. Interposition autogenous vein graft

26. Damage control Arteries that can be ligated with few consequences:
The common and external carotid, subclavian, axillary , internal iliac arteries & Celiac axis.
ICA ligation : 10-20% stroke rate.
EIA,CFA & SFA: high risk of limb ischemia.
SMA & IMA : gut necrosis

27. Damage control
Almost all veins including the IVC can be ligated when necessary

29. Blunt Thoracic Aortic Trauma
Deceleration injury.
Multiple trauma victims
It is lethal if not recognize and treated promptly
Usually distal to left subclavian artery.

33. Neck Trauma Most commonly penetrating type.
Associated vascular injury in > 30%

35. Assistant professor and consultant Vascular Surgery
Thank You
Badr Aljabri, MD, FRCSC
Assistant professor and consultant Vascular Surgery