Damage control of peripheral vascular trauma - Don’t be afraid of axillary or popliteal fosses
Abstract
Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient’s life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed postoperatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. All permanent or temporary vascular procedures should be followed by a definitive repair within the first 8 hours. An early diagnosis and opportune intervention are fundamental to preserve the function and perfusion of the extremity.
Authors
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Keywords
- Peripheral vascular trauma
- vascular trauma of extremities
- hemodynamically unstable
- damage control surgery
- Vascular System Injuries
- Popliteal Artery
- Femoral Artery
- Advanced Trauma Life Support Care
- Axillary Artery
- Tourniquets
- Fasciotomy
- Ankle Brachial Index
- Endovascular Procedures
Author Biographies
, Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia.
https://orcid.org/0000-0002-4526-7636
, Universidad Icesi, Cali, Colombia. Division of Transplant Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia
https://orcid.org/0000-0002-5502-5745
, Division of Surgery, Hospital Felix Bulness, Santiago de Chile, Chile.
https://orcid.org/0000-0002-6186-1440
, Escuela de Medicina, Facultad de Salud, Universidad del Valle, Cali, Colombia.
https://orcid.org/0000-0002-5318-0397
, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
https://orcid.org/0000-0002-6128-0128
, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
https://orcid.org/0000-0003-2516-4004
, Universidad Icesi, Cali, Colombia.
https://orcid.org/0000-0001-9081-5016
, Centro Médico Imbanaco, Cali, Colombia.
https://orcid.org/0000-0003-4769-9384
, Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA
https://orcid.org/0000-0001-6496-6275
, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia.
https://orcid.org/0000-0003-4495-7405
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