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dr jashwant patel
M.S, M.ch, F I A C S
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Dr. Jashvant Patel 1st nominated by : The American Biographical Institute for GREAT MINDS OF THE 21ST CENTURY
(FIFTH EDITION)

Dr. Jashvant Patel 1st nominated by : The American Biographical Institute for GREAT MINDS OF THE 21ST CENTURY
(FIFTH EDITION)

 
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Vascular Injuries
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Vascular trauma
Vascular trauma can result from either blunt or penetrating injury
Penetrating injury is more common in the USA than Europe
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
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 hematoma
Distal ischemia
Investigation
Hard signs often require urgent surgical exploration without prior investigation
Arteriography should be considered:
  • To confirm extent of injury in stable patient with equivocal signs
• 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:
  • Control life-threatening haemorrhage
• Prevent limb ischaemia
If surgery is delayed more than 6 hours revascularization is unlikely to be successful
The use of arterial shunts is controversial
May reduce ischemic time and allow early fixation of fractures
Vascular repair
Usually performed after gaining proximal control and wound debridement
Options include :
  • Simple suture of puncture hole or laceration
• Vein patch angioplasty
• Resection and end-to-end anastomosis
• Interposition graft
Contralateral saphenous vein is the ideal interposition graft
Prosthetic graft material may be used if poor vein or bilateral limb trauma
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