Editing Vascular trauma (section)

= Principles of open vascular repair: =

* Consider pre-op angio
* Consider pre-emptive fasciotomy
* Widely prep, with autologous conduit in mind
* Use an incision that can be extended if necessary
* Proximal control is KEY - preferably proximal to an anatomic barrier
* Distal control is not completely obligatory, and can often be acquired through the haematoma
* Explore the vessel by working in the peri-adventitial plane - look for pearly-white arterial wall with vaso-vasorum on it
* Define injury early:
** Which vessels are involved?
** How bad is it? Laceration, transection, or both?
** Where are you? Are there other structures or major vessels nearby?
* Decide between complex vascular repair and damage control
** Overall patient condition
** Your skills and the environment
* Damage control
** Ligation
*** External carotid artery
*** Coeliac axis
*** Internal iliac
*** Most large veins can be ligated with impunity - vein repair is a luxury, not a must
*** Avoid ligating portal vein where possible
** Temporary shunts
*** Use whatever is available
*** Failure is due to:
**** Failed inflow (proximal injury and residual clot)
**** Obstructed outflow (residual clot or migration or shunt)
**** Obstructed shunt (ligation too tight or kinked)
**** Shunt dislodgement (rapidly expanding haematoma)
** Definitive repair
*** End-to-end anastomosis
**** Often very hard to get enough length and you end up doing interposition graft regardless
*** Patch angioplasty
*** Interposition graft
**** Best option in a completely transected artery

















[[Category:Vascular]]