Vascular Trauma: Occurrence Mechanism, Diagnosis and Treatment Strategy

Abstract

Vascular trauma includes arterial and venous injury. In the paper, arterial injury, in which delay in diagnosis is often fatal, is mainly discussed with various experiences in Awaji Medical Center. As its occurrence mechanism, penetrating sharp and blunt trauma due to direct or indirect force are mentioned, and iatrogenic injury is also often experienced. Clinical findings show hemorrhage, hematoma and pseudoaneurysm, and, in blunt trauma, arterial dissection and intimal injury might induce impaired blood flow. In diagnosis, enhanced computed tomography is given as first choice because multiple organ injuries are often associated, and subsequent arteriography is often required to evaluate blood flow in detail. In treatment, direct suture, patch repair and graft replacement are employed for injured sites, and endovascular treatment such as arterial embolization and placement of stent graft are also adopted according to damaged sites and conditions. In addition in treatment strategy., emergent operation under resuscitative endovascular balloon occlusion of aorta and damage control surgery might be taken into consideration for hemorrhagic shock and multiple organ injuries with stable vital, respectively. Here, various pathologies and treatment methods are mainly discussed for vascular injury.