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37 • Brazil 405
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Fig. 37.5 Motorcycle polytrauma with multiple fractures of right upper limb, right brachial plexus injury, right subclavian artery (SCA) injury, and right
pulmonary contusion. (A) Digital subtraction angiography reveals filling defect in SCA. The defect was crossed with Viabahn 9- × 100-mm stent (B) with
satisfactory restitution of flow (C).
hemorrhage, and cardiac tamponade. The classic presentation of the Beck triad (jugular turgidity, choking of
heart sounds, and hypotension) occurs in less than 40%
of cases11 (Fig. 37.6).
Thoracic Vascular Trauma
Given the prevalence of automobile crashes in Brazil, experience with blunt thoracic aortic injuries is considerable. Like
other developed regions of the world, diagnosis of this injury
is now almost solely based on contrast-enhanced CT imaging and/or magnetic resonance imaging (MRI). Contrast
angiography is typically reserved for use during stent graft
repair of blunt aortic injury, which is now the approach of
choice for the majority of these types of injuries
12,13
given
the low mortality rates (less than 5%) associated with thoracic endovascular aortic repair (TEVAR) and the much
higher rates observed with surgical repair of blunt thoracic
aortic injury (10% to 35%).
2,3
As is the case in other parts
of the world, the challenge is to make this treatment more
widely available in rural as well as metropolitan areas.
Abdominal Vascular Trauma
The authors prefer an open approach (i.e., laparotomy) to
abdominal aortic injuries (blunt or penetrating). Because
of the propensity for large resuscitation and damage to hollow viscus or solid organs, principles of damage control laparotomy are espoused by the authors, focusing on patient
physiology and resuscitation while controlling hemorrhage
and contamination, while also planning to return to the
operating room at a later time for more denitive repair.
14–16
Extremity Vascular Trauma
Such injuries often require a multidisciplinary approach
that includes vascular, trauma, and orthopedic surgeons.
Like other anatomic areas of vascular injury, the priorities
in the extremities are to control hemorrhage and to restore
perfusion. However, unlike other anatomic areas, fracture
reduction and stabilization must be considered alongside
vascular repair, which is often necessary. Following hemorrhage control, fracture reduction and alignment is usually
accomplished. The authors typically proceed with reestablishing perfusion to the limb prior to skeletal xation. This
can be accomplished with a formal vascular reconstruction
or with the use of temporary vascular shunts. If shunts are
used, they are removed and vascular repair is performed after
the fracture xation has been completed. Another important consideration is adequate soft-tissue coverage of the
vascular repair. If tissue destruction is such that this cannot be accomplished with the vascular graft routed in the
normal or in-situ position, the authors favor extraanatomic
bypass to reduce the risk of infection and disruption. Difculties in acquiring suitable prosthetics and rehabilitation for amputees in Brazil emphasize the need for surgical
teams to maximize efforts at limb salvage in patients with
extremity vascular injury.
17,18
Training the Next Generation of
Trauma Surgeons
Learning from our own experience and mindful of military
practice and reports from around the world, there are two
clinical settings by which trauma-training opportunities
can be exploited in Brazil.
demic university hospitals that are associated with medical
schools and which received trauma patients. The second
concerns a larger collection of hospitals, mostly public, that
have a long history with and experience of caring for trauma
victims, but which do not offer opportunities for formal academic study within the eld of trauma surgery. To become
a general surgeon in Brazil, the doctor must always perform a minimum of 2 years of general surgery residency—
one can then be certied as a general surgeon and practice
acute care surgery. A further 2 to 3 years specialization (e.g.,
in Vascular Surgery) is required to develop specialist skills.
Some residency programs supplement the initial 2 years of
general surgical training with advanced general surgery for
an additional 2 years. Specialist surgeons in Brazil have two
titles: general surgeon and another title that reects their
specialty.
In Brazil, annually there are 55 vacancies for medical
residency programs in trauma surgery, distributed across
9 states. These residency programs consist of 2 years of general surgery plus 1 year of training in trauma. This pro g ram
is still decient with respect to accumulation of trauma
8–10
The rst setting is within aca-
406 SECTION 5 • Global Perspectives on Vascular Trauma
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Fig. 37.6 High-velocity projectile heart injury with repair of heart on
cardio-pulmonary bypass (A) and retrieval of “lost bullet” (B).
experience, due to the complexity of this specialty. However,
graduates of these programs are a prized commodity as the
vast majority of trauma and emergency surgery in Brazil is
performed by surgeons with only 2 years of general surgery
training or specialists with 2 years of general surgery and a
further 2 or 3 years of any (non trauma) specialty training.
To address some of these challenges, professional societies
such as SBAIT, created in 1984, have been offering annual
meetings and many training courses for all health-care
providers in trauma.
In conclusion, it is the authors’ viewpoint that the
future of vascular surgery, specically vascular trauma, is
very promising in Brazil. It is a good sign for the country
and region that the overall indices of urban violence are
decreasing and that the number of established and capable
trauma centers is increasing. Challenges remain as to the
“best training paradigms” for trauma and vascular surgery;
however, with the emergence of improved methods of damage control and resuscitation and with the rapid acceptance
of catheter-based, endovascular techniques to treat some
forms of vascular injury, patients with this challenging
injury pattern stand to have improved outcomes.
19–21
References
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miology). In: Rossi M, ed. Trauma Vascular. Rio de Janeiro: Revinter;
2006:74–82.
2. Waiselsz JJ. Novos padrões da violência homicida no Brasil, São Paulo:
Mapa da Violência. Instituto Sangari; 2018.
3. Rossi M, Loureiro E, Villas-Boas R. Traumatismo vascular (Vascular
trauma). In: Brito CJ, eds. Cirurgia Vascular. Rio de Janeiro: Revinter;
2013:1651–1688.
4. Stannard A, Brown K, Benson C, Clasper J, Midwinter M, Tai NR. Out-
come after vascular trauma in a deployed military trauma system. Br
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5. White JM, Stannard A, Burkhardt GE, Eastridge BJ, Blackbourne LH,
Rasmussen TE. The epidemiology of vascular injury in the wars in
Iraq and Afghanistan. Ann Surg. 2011;253(6):1184–1189.
6. Marín-León L, Belon AP, Barros MB, Almeida SD, Restitutti MC. Trends
in trafc accidents in Campinas, São Paulo State, Brazil: the increasing
involvement of motorcyclists. Cad Saude Publica. 2012;28(1):39–51.
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7. Ball CG. Damage control surgery. Curr Opin Crit Care. 2015;21(6):
538–543.
8. Eastridge BJ, Mabry RL, Seguin P, etal. Death on the battleeld (2001–
2011): implications for the future of combat casualty care. J Trauma
Acute Care Surg. 2012;73(6 suppl 5):S431–S437.
9. Rasmussen TE, Gross KR, Baer DG. Where do we go from here?
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10. Bailey JA, Morrison JJ, Rasmussen TE. Military trauma system
in Afghanistan: lessons for civil systems? Curr Opin Crit Care.
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11. Bellister SA, Dennis BM, Guillamondegui OD. Blunt and penetrating
cardiac trauma. Surg Clin North Am. 2017;97(5):1065–1076.
12. Brown J, Sajankila N, Claridge JA. Prehospital assessment of trauma.
Surg Clin North Am. 2017;97(5):961–983.
13. Cline M, Cooper KJ, Khaja MS, Gandhi R, Bryce YC, Williams DM.
Endovascular management of acute traumatic aortic injury. Tech Vasc
Interv Radiol. 2018;21(3):131–136.
14. Coleman JJ, Zarzaur BL. Surgical management of abdominal
trauma: hollow viscus injury. Surg Clin North Am. 2017;97(5):
1107–1117.
15. Harris DG, Rabin J, Starnes BW, et al. Evolution of lesion-specic
management of blunt thoracic aortic injury. J Vasc Surg. 2016;
64(2):500–505.
16. Ho XN, Wee IJ, Syn N, Harrison M, Wilson L, Choong AM. The
endovascular repair of blunt traumatic thoracic aortic injury in Asia: a
systematic review and meta-analysis. Vascular. 2019;27(2):213–223.
17. Hornez E, Boddaert G, Ngabou UD, etal. Temporary vascular shunt
for damage control of extremity vascular injury: a toolbox for trauma
surgeons. J Visc Surg. 2015;152(6):363–368.
18. Ivatury RR, Anand R, Ordonez C. Penetrating extremity trauma.
World J Surg. 2015;39(6):1389–1396.
19. Johnsen NV, Betzold RD, Guillamondegui OD, et al. Surgical
management of solid organ injuries. Surg Clin North Am. 2017;
97(5):1077–1105.
20. Phillips B, Reiter S, Murray EP, etal. Trauma to the superior mesenteric
artery and superior mesenteric vein: a narrative review of rare but
lethal injuries. World J Surg. 2018;42(3):713–726.
21. Reddy NP, Rowe VL. Is it really mandatory to harvest the contralateral
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cular Surg. 2018;52(7):548–549.
Index
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Note: Page numbers followed by “f ” refer to illustrations; page numbers followed by “t ” refer to tables; page numbers followed by “b” refer to boxes.
A
Abdomen, zones of, 339, 340f
Abdominal aorta, injury to
blunt, 304
penetrating, 304
Abdominal aortic trauma, 212
anatomy in, 213, 213f
aortic injuries in, 216–218
follow-up for, 218
investigations on, 217
treatment of, 217–218, 218f
in central retroperitoneal area (zone I), 213
clinical presentation of, 213–214
complications of, 222
endovascular balloon occlusion, 224–225
endovascular treatment of, 222–225
embolization in, 222–223
solid organs and pelvic trauma, 223
iliac artery in, injuries to, 220–221, 221b
investigations in, 214
mechanism of injury in, 212–213
in pelvic retroperitoneum (zone III), 213
surgical management of, 221–222
surgical techniques for, 214–216
in upper lateral retroperitoneum (zone II),
213
visceral arteries in, injuries to, 218–220
celiac artery and branches, 218
endovascular treatment for, 220
inferior mesenteric artery, 219
mortality in, 220
renal artery, 219–220
superior mesenteric artery, 218–219
Abdominal hemorrhage, 62–63
Abdominal injuries, vascular conduit for, 304
Abdominal vascular injuries, 83
in austere environment, surgery for, 339–
341, 340f, 341f
clearing trauma patients from, 87b
organ injury scale for, 227t
Abdominal vascular trauma, 405
ABI. See Ankle-brachial index (ABI)
Access to care, in Australia and New Zealand,
353–354
Acidosis, coagulopathy in, 71
ACS COT. See American College of Surgeons
Committee on Trauma (ACS COT)
Acute ischemia, management of, 393
Acute respiratory distress syndrome (ARDS),
161
Acute traumatic coagulopathy (ATC), 65–66,
65f, 66f
Adenosine, administration of, 11
Advance dressing stations (ADS), 359
Advanced Surgical Skills for Exposures in
Trauma (ASSET), 49–50, 50f, 50t, 366
Advanced Trauma Life Support (ATLS), 71, 354,
370, 388, 393
guidelines for patient assessment for vascular
injury, 86
injured extremity assessment guidelines, 324
Advanced Trauma Operative Management
(ATOM), 49
Aerodigestive injuries, in carotid/vertebral
injuries, 242–243
Afghanistan
military vascular surgery in, during Gulf
War, 20
vascular injury rates, 388
Air-bag, ination of, blunt thoracic injury and, 3
Air leaks, as lung injury complication, 27
Alcohol and drug consumption, 365
Alliance for Physician Certication and
Advancement (APCA), 98
Allografts, 302
Alpha (α) Angle, 76
American Association for the Surgery of Trauma
(AAST), 318
organ injury scale for abdominal vascular
injury, 226, 227t
American College of Surgeons (ACS),
verication system for systems of
care, 353
American College of Surgeons Committee on
Trauma (ACS COT)
Resources for the Optimal Care of the Injured
Patient, 36
Verication Review Committee, 36
AMPLTZER Vascular Plugs (AVPs), 116
Amputation, 333f
in complex upper extremity vascular trauma,
254
forequarter, 347
versus salvage, 322
Analgesia, for lung injuries, 24
Anastomosis
of artery, rst end-to-end, 15, 15f
techniques, 281
Anastomotic stenosis, 382
Anatomy. See Surgical anatomy
Angiography, 91–97, 92t
complications of, 97
in iliac artery injuries, 221
indications for, 91–93
on-table, 96
operative strategy in, 94–96, 94f, 95f
operative technique in, 96–97, 96f, 97f
pitfalls and danger points of, 94
portable, for vascular injury, 88
postoperative care in, 97
preparation for, 93
transcatheter, 91–93
Animal-derived conduits (xenografts), 303
Ankle-brachial index (ABI), 87
Anterolateral thigh (ALT) ap, 329, 329f
Anterolateral thoracotomy, 3
bilateral, 4
and pericardiotomy, 9–10
left, 4, 5f
Anticoagulation, in temporary vascular shunts,
295–296
Antipersonnel mines (APMs), 357–358
Antiplatelet therapy, dual, for blunt carotid/
vertebral injuries, 242
Antithrombotic therapy
for cervical arterial injuries, 242
postoperative, 249
Antyllus, 13
Aortic clamping, thoracic, 4, 5f, 6f
Aortic injuries, 216–218
investigations on, 217
treatment of, 217–218, 218f
Aortic stenting, 208
Aortocaval stulas, abdominal vascular injuries
and, 214
Aortogram, of thoracic aortic stent-graft
placement, 355f
Aortography
in blunt thoracic aortic injury, 201
of traumatic false aneurysm, 200f
Aortorrhaphy, 19
APMs. See Antipersonnel mines (APMs)
Archigenes, 12
Argyle shunt, 292f, 292t, 293f
Arrhythmias, blunt cardiac injury and, 9
Arterial access, for REBOA, 128–129, 129f
Arterial conduits, 301
Arterial stulas, abdominal vascular injuries
and, 214
Arterial injury, 332, 333f
Arterial occlusion, 273
angiographic ndings in, 92t
ultrasound ndings in, 98t
Arterial repair
nonsuture method of, during World War II,
18, 18f
performed by Halowell, 14f
Arterial stenosis
angiographic ndings in, 92t
ultrasound ndings in, 98t
Arterial suture, techniques for, 16
Arterial trauma, ligation for, 12
Arterial wall disruption, 274
Arteriogram
in lower limb vascular injuries, 342f
in upper limb vascular injuries, 338f
Arteriography
in axillary artery injury, 260
trauma, technical sophistication of, 94
Arteriovenous stula
angiographic ndings in, 92t
ultrasound ndings in, 98t
Articial blood vessels, 307–308
Articial Kidney Initiation in Kidney Injury
(AKIKI) trial, 160
Ascending aortic arch, penetrating wound
of, 19
Association for the Surgery of Trauma (AAST),
117
ATLS. See Advanced Trauma Life Support (ATLS)
ATOM. See Advanced Trauma Operative
Management (ATOM)
Atriocaval shunt, 237–238, 238f
Auckland City Hospital Trauma Registry, 353
Austere environment
vascular surgery in, 332
working in, 347–350
Australia, vascular trauma in
access to care in, 353–354
considerations for diagnosis of, 354–355
epidemiology in, 353
407
408 Index
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Australia, vascular trauma in (continued)
prehospital care in, 354
strategies for sustaining and training of
trauma surgeons in, 356
surgical training and certication in, 353
systems of care in, 353
treatment strategies in, 355, 355f
Autologous conduit, 301
in austere and military settings, 306–307, 307f
Autologous graft, denitive vascular repair with,
327
Autologous vein
conduit, 305t
use of, 307
Automated partial aortic ow control, 138–142
limitations, 141
regional perfusion optimization, 138–141,
139f, 140f, 141t
Automobile crashes, 393
in Brazil, 402–403
Axillary artery
anatomy of, 260, 261f
complete exposure of, 338f
Axillary artery approach, 398–400, 399f
Axillary artery injuries, 260–261
operative management of, 260
operative technique of, 260–261
tourniquet in, 254–255
B
Balloon and sheath removal, for REBOA, 131
Balloon catheter thrombectomy, 317
Balloon deation, for REBOA, 130–131
Balloon-expanding stents, 116–117
Balloon ination, for REBOA, 130
Balloon occlusion, for hemorrhage control,
230, 237
Basic Endovascular Skills for Trauma (BEST), 51
Basilic vein, as conduit, 306
BCVI. See Blunt cerebrovascular injuries (BCVI)
Bec de corbin, 13, 13f
Beck’s triad of hypotension, 7
Biologic conduits
allografts, 302
xenografts, 302
Bleeding
control of
in inferior vena cava injuries, 230–232, 231f
in portal vein injuries, 234–235
in superior mesenteric vein injuries, 236
embolization in, 222–223
limb wound, 361
Blood pressure, in thoracic aortic injuries,
202–203
Blood transfusion, 78
Blunt abdominal vascular injury, 212–213
Blunt aortic injury (BAI), 304
Blunt cerebrovascular injuries (BCVI), 122t, 316
Blunt injury, 212–213
thoracic aortic, 199
Blunt thoracic aortic dissection, 395
Blunt thoracic aortic injury (BTAI), 199
aortography in, 201
chest x-ray in, 201, 201f
clamp-and-sew technique in, 204, 205f
classication of, with treatment guidelines,
202f
CT scan in, 201, 202f
denitive management of, 203–209, 204t
timing of, 203, 203f
diagnosis of, 200–202, 202t
endograft design for, advances in, 207–208
endovascular aortic repair for, 205–207, 206f
complications in, 207t, 208f
versus open repair, 208t
epidemiology of, 199–200, 199f
history of, 199
initial management of, 202
natural history of, 200
nonoperative management of, 209
open surgical repair of, 204–205, 205f
versus endovascular aortic repair, 208t
region-specic treatment strategies of, 355
screening of, 200–202, 201f
site of, 200, 201f
TEE in, 202, 202t
type of, 200, 201f
Blunt thoracic aortic rupture, computed
tomography of, 354f
Blunt trauma, 391
in abdominal vascular injuries, 212
carotid traumatic dissection secondary to,
354f
to great vessels
diagnosis of, 17
etiology of, 14, 14f
incidence of, 13
presentation of, 14–15, 16f
to heart
diagnosis of, 9
incidence of, 7
presentation of, 7
in iliac artery injuries, 220
to lungs
etiology of, 23
incidence of, 23
thoracic CTA for, 102
Bony pelvis, stabilization of, 223
Boris Matveev, Colonel, 374
Boyden, Allen M., 18
Brachial artery, anatomy of, 261–262, 262f
Brachial artery injuries, 261–263, 318
operative management of, 262–263,
263f
operative technique of, 263
Brachial plexus injury, 241, 243
Brachioradialis ap, 345, 345f
Brazil, vascular trauma in, 401
automobile crashes, 402–403
endovascular facilities, 404
epidemiology of, 401–403
evaluation and diagnosis, 403
homicide rates, 401, 402t
patterns and treatment strategies, 403–405
rural setting, 401–402
training next generation of trauma surgeons,
405–406
urban setting, 401
Brener shunt, 292t
Brukhonenko, Sergey, 374
BTAI. See Blunt thoracic aortic injury (BTAI)
Burbank shunt, 292t
C
Cadaver-based training, in vascular exposures, 46
Calcium, 67
Calf fasciotomy, 285
Cardiac arrest, 152
Cardiac box, 3
Cardiac compression, with sternal closure, 21
Cardiac failure, after repair of injury and, 12
Cardiac, great vessel, and pulmonary injuries, 1
advanced trauma life support in, 3–5
evaluation and management of, in emergency
center, 3–5
mechanism of, 3
Cardiac injuries, 404, 406f
penetrating, 395
Cardiac rhythm, restoration of, for great vessel
injuries, 11
Cardiac tamponade, 7
“Cardio-Stable” induction strategies, 74–75
Cardiovascular management, 75–76
C-arm uoroscopy system, 96
Carotid artery, external, bleeding from, ligation
for, 334
Carotid artery injuries, 241
operative strategy and technique for,
243–245, 245f
penetrating right common, ePTFE
interposition graft in, 308f
repair of, 241
Carotid artery trauma, penetrating, 249
Carotid injuries, 404
in austere environment, vascular surgery for,
333–334, 334f, 335f
Carotid-jugular stulae, 334
Carotid traumatic dissection, secondary to blunt
trauma, 354f
Carrel, Alexis, 300
Catastrophic hemorrhage, control, 72–73
Catheter angiography
in iliac artery injuries, 221
for vascular injury, 89
Cattell-Braasch maneuver, 341, 341f
Ceiling-mounted system, 109, 109f
Celiac artery, injuries to, 218
Celsus, 12
Cerebral edema, management of, 249
Cerebral ischemia, 21
Cervical and torso vascular injuries, 316
Cervical collar, for penetrating neck injuries, 334
Cervical vascular injury, 122–123
Cervicomediastinal injuries, 394–395
CFA. See Common femoral artery (CFA)
Chest radiograph, anteroposterior, in mediastinal
vascular injury, 83
Chest vascular injuries, clearing trauma patients
from, 87b
Chest x-ray
for lung injuries, 24
for penetrating injuries, 4–5
in screening of blunt thoracic aortic injury,
201, 201f
CIN. See Contrast-induced nephropathy (CIN)
Circulatory arrest, vein injuries and, 238
Civilian and military arterial injury, 273, 274t
Civilian lower extremity vascular injury, 275,
276t
Civilian vascular injury, 26–29
Clamp-and-sew technique, 204, 205f
Clamping, cross, 25
Clinical practice guideline (CPG), in systemizing
vascular-injury care, 39
Clinical trials
designs, 168
methodological and practical challenges,
167–168
Closed incision site, 400f
Coagulation, optimization of, 76–77
Coagulopathy
pathophysiology of, 71–72
acidosis, 71
endothelial dysfunction, 71–72
hemodilution, 71
hypothermia, 71
tissue trauma, 71
in trauma, 65, 65f
Coil embolization, in control of bleeding, 223
Coils, 115–116
College of Medicine of South Africa, 2-year
Higher Surgical Diploma, 393
Index 409
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Colombia
vascular trauma in, 396
axillary artery approach, 398–400, 399f
posterior popliteal artery approach,
396–398, 397f, 398f
Colombo Army Hospital (CAH), 359
COMBAT randomized controlled trials, 74
Combat-action tourniquet, 355, 355f
Combat casualty care (CCC), 374
trauma systems in, 36–37
Combat medics, 374
Combat-related geography, terrain, and weather,
357, 358f
Combat troops, vascular trauma in, 25–26
Common carotid artery, blunt tear of, repair of, 21
Common femoral artery (CFA), 281–282, 281f,
282f
Compartment pressure, normal, 268
Compartment syndrome
axillary or subclavian artery repair and, 249
and fasciotomy, 318, 318f
upper extremity vascular injury and,
268–269, 269b, 269f
vascular injury and, 89–90, 89f
Complex injuries, 378–379, 381f
Comprehensive vascular skills assessment
(CVSA), 48
Computed tomography (CT), 101–105, 102f
for blunt thoracic aortic injury, 201, 202f,
202t
for blunt thoracic aortic rupture, 354f
for caval injury, 228
complications of, 105
historical background of, 91
indications for, 102–103, 102f, 103f
pitfalls and danger points of, 104
postexamination care in, 105
preparation, 103
strategy for, 104
technique for, 104–105
Computed tomography angiography (CTA),
354–355, 370, 396
of carotid and vertebral injuries, 241
in iliac artery injuries, 221
of neck and thoracic outlet vascular trauma,
241
pediatric vascular injury, 313–314, 314f
performance of, 242–243
three-dimensional, 105
two-dimensional, 105
Computed tomography arteriography, 17
Concomitant injuries, 363
Concomitant vein injury, 277–278
Cone-beam computed tomography (CBCT), 110
Continuous RRT (CRRT), 158
Continuous veno-venous hemodialtration
(CVVHDF), 158–159
Continuous veno-venous hemo-dialysis
(CVVHD), 158–159
Continuous veno-venous hemoltration (CVVH),
158–159
Continuous-wave Doppler, 313
Contrast arteriography, in lower limb vascular
injuries, 342, 342f
Contrast-induced nephropathy (CIN), 93
Counter-terrorist operations in the North
Caucasus region (CO-NC), 374
CPG. See Clinical Practice Guideline (CPG)
Cranial nerves, 243
CRASH-2 study, 67
Crew resource management (CRM), 46
Cross-clamping, of hilum of lung, 25
Cross-leg ap, 346, 348f
Crossover left innominate vein, 21
Crush injuries, in abdominal vascular injuries,
212–213
Cryopreserved allograft conduit, 305t
Cryopreserved arterial allografts, 302–303
Cryopreserved artery, 302–303
Cryopreserved saphenous vein allografts, 302
CT. See Computed tomography (CT)
CTA. See Computed tomography angiography
(CTA)
CVSA. See Comprehensive vascular skills
assessment (CVSA)
D
Damage control, considerations for conduit
repair of vascular injury, 300
Damage control resuscitation (DCR)
for thoracic trauma, 4
for vascular trauma, 70
denitions, 70
emergency department reception, 72–77
future development of, 78–79
Damage control surgery (DCS), 70
Data collection, in systemizing vascular-injury
care, 38–39, 39b
DCR. See Damage control resuscitation (DCR)
DCS. See Damage control surgery (DCS)
DeBakey, vascular injury burden in WWII, 25
Debranching and reimplantation of arch-
branches, 208, 209f
Debridement, in complex upper extremity
vascular trauma, 254
Deceleration
injury, 3
severe, in abdominal vascular injuries, 212–213
Decision making, in choice of vascular conduit,
304–306
Deep cerebellar, 283
Deep venous thrombosis (DVT), duplex scanning
for, 98
Denitive Surgical Trauma Care (DSTC), 48,
366, 393
Denitive Surgical Trauma Skills (DSTS), 48–49
Denitive vascular reconstruction, 362
Degloving component, in injured extremity, 324
Degloving injury, 326–327
Diagnosis of vascular injury, 82
clearing trauma patients from presence of,
87–88, 87b
compartment syndrome and, 89–90, 89f
denitive diagnosis of, 88–89
catheter angiography in, 89
multidetector CT angiography in, 89
portable angiography in, 88
surgical exploration in, 88, 88f
hard signs of, 86b
mechanism, setting, and patterns of, 82
pattern of recognition in, 82–86
abdominal, 83
head and neck, 82–83, 84f, 85f
high-risk, 86
lower extremity, 85–86
thoracic, 83, 85f
upper extremity, 84, 86f
penetrating, 82
physical examination of, 86–87, 86b
soft signs of, 86b
Digital subtraction angiography (DSA), 96, 378
Direct anastomosis, 396
Disability, assessment of, 74
Dislocation, elbow, brachial artery injury and, 261
Distal extracranial (zone III) carotid
pseudoaneurysm, 316
Distal ischemia, dislocated knee associated with,
354f
Distal popliteal exposure, 283
Doppler ultrasound, adjunctive measures, 87
DSA. See Digital subtraction angiography (DSA)
DSTC. See Denitive Surgical Trauma Care (DSTC)
DSTC course, 395
DSTS. See Denitive Surgical Trauma Skills
(DSTS)
Duplex color ow imaging, 87
Duplex ultrasound scanning (DUS), 98
DVT. See Deep venous thrombosis (DVT)
Dzhanelidze, Yustin, 374
E
Eastern Association for the Surgery of Trauma
(EAST), 117
Ebers’ papyrus, 12
EBVS. See European Board of Vascular Surgery
(EBVS)
ECMO. See Extracorporeal membrane
oxygenation (ECMO)
Education in vascular trauma, Sweden, 373
EFAST. See Extended FAST examination (EFAST)
Egyptians, ancient methods of hemostasis by, 12
Ekk, Nikolai, 374
Elbow dislocation, brachial artery injury and, 261
Elective peripheral vascular bypass, studies of, 300
Ellis, 14
Embolization agents, 114–116
permanent, 115–116
coils, 115–116
plugs, 116
thrombin, 115
temporary, 114–115
for trauma, 115t
Embolization, control of bleeding by, 222–223
complications in, 224
Emergency center thoracotomy, 3–5
Emergency department (ED)
management, 75–77
reception, 72–77
Emergency vascular service, 111–113
clinical need, 111, 112f, 112t
practical implementation, 111–112
training issues, 112
Empyema, 27
Endograft design, advances in, 207–208, 209f
Endothelial dysfunction, 71–72
Endovascular aortic repair (EVAR), 372–373
for thoracic aortic injuries, 205–207, 206f
complications in, 207t, 208f
versus open repair, 208t
Endovascular balloon occlusion, 224–225
Endovascular grafts, 235
for hemorrhage control, 230
Endovascular hemorrhage control, principles
of, 114
Endovascular repair of injured vessels, 383,
384f, 385f
Endovascular resuscitation, 154–156
clinical decision-making in, 149
rationale for, 147–149
Endovascular Resuscitation and Trauma
Management (EVTM), 51, 372–373
Endovascular Skills for Trauma and Resuscitative
Surgery (ESTARS), 51
Endovascular suites
imaging capability, 110–111, 110f, 111f
organizational issues, 109–110
principle, 108
room design, 108–109, 109f
Endovascular surgery, 45
Endovascular techniques, in vascular surgery,
236–238
Endovascular therapy, 248–249
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Endovascular variable aortic control (EVAC),
138–142
Epidemiology, denition of, 23
EPTFE. See Expanded polytetrauoroethylene
(ePTFE)
Ethics, of resuscitation, 77–78
Ethnicity, vascular trauma and, 28–29
Etomidate, 75
European Board of Vascular Surgery (EBVS), 48
European Trauma Course (ETC), 366
European Vascular Masterclass (EVM), 50–51
EVM. See European Vascular Masterclass (EVM)
EVTM. See Endovascular resuscitation and
trauma management (EVTM)
Expanded polytetrauoroethylene (ePTFE), 246f,
278, 302, 307, 308f
Exsanguination, 25
Extended FAST examination (EFAST), 23–24, 98
External carotid artery, 301
External carotid-internal carotid transposition,
247f
Extraanatomical bypass, 222
Extracorporeal life support (ECLS), 161
Extracorporeal membrane oxygenation (ECMO),
161–162, 317
Extremity compartment syndrome, 297
Extremity hemorrhage, 56–58
practicalities, 58, 58b
principles, 56–58, 57f
Extremity injuries, 321
assessment of, 324–325, 325t
incidence of, 26
Extremity vascular injuries
among local national populations, 26
lower. See Lower extremity vascular injuries
repair of, 314–316, 315f
upper. See Upper extremity vascular injury
Extremity vascular trauma, 123, 405
Extremity vessels, vascular conduit for, 304
F
Faltin, Richard, 366
Fasciocutaneous aps, 345–346, 345b, 347f
for lower limb wounds, 329
Fasciotomy, 285–286, 285f
absolute indications for, 344
compartment syndrome and, 318, 318f
indications for, in combat setting, 268, 269b
performance of, for extremity injuries, 327
prophylactic
ligation of vena cava and, 232
temporary vascular shunt and, 297
of upper extremity, 268, 269f
Finland, vascular trauma in, 365
northern European example in trauma and
trauma care, 365–366
surgery training, availability, and challenges,
366–368, 367f
vascular and trauma surgery, 366
Firearm deaths, 365
Firearms, 312
Fix and ap reconstruction, 328
Fixed imaging units, 96–97, 97f
Flap reconstruction, 328–329
Flat panel detectors (FPD), 110
Fleming, 13–14
Floor-mounted system, 108–109, 109f
Focal dissection, 273
Focused assessment with sonography for trauma
(FAST), 98
Fogarty catheter embolectomy, 397f
Fogarty catheters, 343
Forearm
amputation, 347, 349f
compartments of, 338–339
compartment syndrome in, 89
machete wound to, 338–339, 340f
Forearm artery injury, 263
Fracture-associated extremity vascular trauma,
321
Fractures
blunt thoracic aortic injury and, 83
of humerus, axillary artery injury and, 260
open, 321–322, 322t
stabilization of site, 326–327
supracondylar, brachial artery injury and, 261
Free aps, 329
Fullen’s classication, of superior mesenteric
artery injury, 219t
Functional motor assessment, of extremities,
325t
Functional sensory assessment, of extremities,
325t
G
Galen, 12–13
Gas exchange, 73–74, 73t
Gastric artery, left, injuries to, 218
Gastrocnemius muscle aps, 345
Gastroepiploic artery, 301
Gelfoam, 114–115
in control of bleeding, 223
General surgical training, 395
Geriatric trauma, 29–30
Glasgow Coma Scale (GCS), 334
Goyanes, 16
Graduate medical education, in vascular trauma,
42–44
Graft or anastomotic stenosis, 276
Grafts
autologous, denitive vascular repair with,
327
endovascular, 230, 237
ePTFE, 302, 307, 308f
interposition. See Interposition graft
panel, 305
spiral vein, for inferior vena cava repair, 233,
233f
stent, 237
Greater saphenous vein (GSV), 280, 314
as conduit, 306
Great vessels, injuries to, 13–22
denition/classication of, 13, 13t
diagnosis of, 17
etiology of, 14
extravascular management of, 17, 17f
history of, 13
incidence of, 13–14
major complications of, 21–22
operative management of, in emergency
department and operating room, 17–21
presentation of, 14–17
survival in, 22, 22t
Groin ap, 347f
Groins, 59
GSV. See Greater saphenous vein (GSV)
Gudov, Vasilij, 374
Gulf War, military vascular surgery during, 20
Gunshot wound
in abdominal vascular injuries, 212
Cattell-Braasch maneuver for, 341f
Gustilo-Anderson classication, of open tibial
fractures, 322t
H
Haire, 13
Hallowell, in early vascular surgery, 14, 14f
Halsted, 14
Hand-held Doppler, 374–375
Hard signs, of vascular injury, 86b, 333
Head vascular injuries, 82–83, 84f
clearing trauma patients from, 87b
“Health Care in Danger,” symposium entitled, 350
Heart, injured, 5–13
diagnosis of, 7–9
history of, 5
incidence of, 5–7
major complications in, 12
nonoperative management of, 9
operative management of, in emergency
department and operating room, 9–12
cardiopulmonary bypass, acute need for,
11, 12f, 12t
cardiorrhaphy, treatment in operating
room after, 11–12
hemorrhage from the heart, control of,
10–11, 10t
incisions in, 9
pericardiotomy, 9–10
suturing techniques, 11
presentation of, 7
blunt trauma, 7
penetrating trauma, 7
survival, 12, 13t
Helicopter emergency medical services (HEMS),
365
Helicopter transport, 370
Heliodorus, 12
Hematoma, retroperitoneal, in major vein injury,
227
Hemodilution, coagulopathy in, 71
Hemodynamic collapse, axillary artery injury
and, 257
Hemopneumothorax, subclavian artery injury
and, 257
Hemorrhage, 114
active, angiographic ndings in, 92t
acute vascular
management of, 393, 393f
external, nger control of, 17
initial control of, 12–14
life-threatening, 86
Hemorrhage control, 360–361, 361f
Hemorrhage-induced traumatic cardiac arrest
(HiTCA), 152–154, 154f, 155f
Hemostasis, Egyptians and, 12
Hemothorax, 23
Henley retractors, 283
Heparin, 300, 317
Heparinized saline, 317
Hepatic artery, injury to, 218
High-energy extremity wounds, 321
High-velocity projectile, in abdominal vascular
injuries, 212
High-volume hemoltration (HVHF), 160–161
Hilar twist, 25
Hollow tubular devices, as temporary vascular
shunts, 290–291
Homicides, 365
Hounseld units (HU), 104
Human acellular vessel (HAV), 303–304, 303f,
308–309
Human umbilical vein (HUV), as conduit, 302
Humeral head, anterior dislocation of, axillary
artery injury and, 260
Humerus, fracture of, axillary artery injury and,
260
Hunter, John, 13
Hunter, William, 13
Hybrid theatre, 367, 368f
Hybrid trauma operating room (HTOR), 108
Hypotension
avoidance of, 243
permissive, 65
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Hypothenar eminence hammer syndrome, 263
Hypothermia, 64–65
coagulopathy in, 71
Hypoxia, avoidance of, 243
I
Iatrogenic femoral artery injuries, 274
Iatrogenic injury, 312
Iatrogenic vascular injuries, 366
Iatrogenic vascular injury, 30–31
IATSIC. See International Association for
the Surgery of Trauma and Surgical
Intensive Care (IATSIC)
IEDs. See Improvised explosive devices (IEDs)
Iliac artery, injury to, 220–221, 221b
Iliac vessel, injury to, 212
Imaging, for vascular trauma, 91
historical background of, 91
modalities in, 91–105
Implantable prosthetic conduit, 288
Improvised explosive devices (IEDs), 301, 388,
389f
massive soft-tissue destruction from, 301f
Inadequate arterial débridement, 382
Incisions
for great vessel injuries, 18–19, 18f, 19f
for lung injuries, 24–25
Inferior mesenteric artery, injuries to, 219
Inferior vena cava (IVC), injuries to, 226
bleeding control in, 230–232, 231f
complication of, 227
considerations for repair of, 232
exposure and mobilization of, 229–230, 230f
ligation in, 232
management options for, 237–238
operative management of, 228–236
pitfalls and points, 238
postoperative care, and complications in, 238
preoperative preparation for, 227–228
reconstructive techniques for, 231f,
233–234, 233f
surgical anatomy in, 229, 229f
vascular repair of, 21
Inow occlusion, for control of hemorrhage,
10–11
Infraclavicular axillary artery, exposure of, for
proximal control, 338f
Infrarenal inferior vena cava, 228–234, 229f
Injuries to named vessels, 281–285
common femoral artery, 281–282, 281f, 282f
isolated profunda femoris injuries, 282, 283f
popliteal artery, 282–284, 283f, 284f
supercial femoral artery, 282
tibial arteries, 284–285, 285f
Injury extremely index (IEI), 313
Injury severity score (ISS), 65, 365–366
In-line shunts, 291–292, 292f, 293f
Innominate artery
blunt tear of, repair of, 20–21, 20f
penetrating wound of, repair of, 19–20
Institute of Cardiology Aloísio de Castro (IECAC),
401, 402f
Intercollegiate Surgical Curriculum Programme
(ISCP), 44
Internal carotid repairs, 243
Internal iliac artery, 301
Internal iliac pseudoaneurysms, 214
Internal mammary (internal thoracic) artery,
301
International Association for the Surgery of
Trauma and Surgical Intensive Care
(IATSIC), 48
Interpersonal violence, 353, 396
Interposition graft, 222
ePTFE, 308f
saphenous, in brachial artery, 307f
Interposition or bypass grafting, technical factors
of, 300
Interposition synthetic graft, 399f
Interposition vein graft, 398f
Intracardiac lesions, delayed diagnosis of, 12
Intravascular shunts
historical use of, 288
modern use of, 288–289, 290f, 291t
civilian trauma experience, 289
military and combat experience, 288–289
Intravascular ultrasound (IVUS), 101, 101f
Iodoxinol, 93
Ionizing radiation, attendant risk in, 94
Iraq, military vascular surgery in, during Gulf
War, 20
Ischemia
acute, management of, 393
in brachial artery injury, 261
Isolated profunda femoris injuries, 282, 283f
Isolated vein injury, 277–278
Israeli Air Force (IAF), 388
Israeli Defense Forces (IDF), 388
Israel, vascular trauma in, 388
IVUS. See Intravascular ultrasound (IVUS)
J
Javid shunt, 290f, 292t
Jerome of Brunswick, 13
Joint Theater Trauma Registry (JTTR), 25
Joint Theater Trauma System (JTTS),
organization of, 37–38
Joint Trauma System (JTS), 36
“Jony mines”, 358
JTS. See Joint Trauma System (JTS)
JTTS. See Joint Theater Trauma System (JTTS)
Judd-Allis clamps, in vein injuries, 231, 231f
Junctional hemorrhage
complex/novel options, 60–61, 60f
hemostatic dressings, 59–60, 60b
practicalities in management, 58–59
principles, 58
Junctional vascular trauma, 123
Junctional zone, of upper extremity
anatomy of, 257
injury to, operative management of, 257–
259, 258f, 259f
K
Ketamine, 75
Knee, dislocation of, 85, 321
associated with distal ischemia, 354f
Korean Conict, vascular surgery during, 19–20
Kunlin, Jean, 300
Kussmaul’s sign, 7
L
Laceration, direct, in abdominal vascular
injuries, 212–213
Lateral malleolar ap, 347f
Late revascularization, 380–382, 382f
Latissimus dorsi (LD) ap, 329
LEAP. See Lower Extremity Assessment Project
(LEAP)
Lethal triad, 64
Liberation Tigers of Tamil Elam (LTTE), 357
Ligated axillary vein, 399f
Ligation
for carotid artery injury, 334
for inferior vena cava injuries, 232
for initial control of hemorrhage, 12
portal vein, 235
of superior mesenteric vein, 236
for vascular trauma, 300
Limb
amputation, 323, 324b
loss of, associated with upper extremity
arterial injury, 253
pre-scrubbing of, 325–327
Limb complications, 276
Limb salvage, 275, 322
in austere environment, 344
outcomes of, 330
role of temporary vascular shunt in,
296–297, 296f
Limb Salvage Index (LSI), 255
Limb-threatening arterial, occlusive injuries
with, 86
Limb trauma, component of, 321
Limb wound infection, 276
Liver injury, 119
Lobectomy, 26
Long venous bypasses, 278
Looped shunts, 291–292, 293f
Low-dose aspirin, 317
Lower extremity
crush injuries of, 85–86
mangled, 307
Lower Extremity Assessment Project (LEAP), 322
Lower extremity vascular injuries, 85–86
characteristics, 273–275
arterial pathology, 273–274, 274f
level of injury, 273
mechanism of injury, 273
clearing trauma patients from, 87b
concomitant and isolated vein injury,
277–278
diagnosis of, 278–279
hemorrhagic and ischemic signs, 278–279,
278t
operative planning considerations, 279t
patient and limb outcomes, 275–277
amputation, 275
functional outcomes and quality of life, 277
limb complications, 276
mortality, 275
presentation of, 278–279
technical aspects of vascular reconstruction,
279–286
conduit, tunneling, twisting, and
measuring, 280
fasciotomy, 285–286, 285f
general considerations, 279–280
injuries to named vessels, 281–285
techniques for anastomosis, 281
workup, 278–279
Lower extremity venous injury, 277, 278t
Lower limb
compartment syndrome, after vascular
trauma, 222
vascular injuries, in austere environment,
surgery for, 342–344, 342f, 343f
wounds, commonly used aps for, 329
LSI. See Limb Salvage Index (LSI)
Lungs, injuries to, 22–26
classication of, 22, 22t
complications to, 27
diagnosis of, 23–24
etiology of, 23
history of, 22
incidence of, 22–23
nonoperative management of, 24
412 Index
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Lungs, injuries to (continued)
operative management of, in emergency
department and operative room, 24–26
indications for, 24, 24b, 25f
proximal vascular control in, 25, 25b
presentation of, 23
survival of, 27, 27t
thoracic damage control in, 26–28, 27b
LY30, 77, 78f
M
Machete wound, to forearm, 340f
Magnetic resonance angiography (MRA),
101–102, 393
Magnetic resonance imaging (MRI), 101–102
Main dressing stations (MDS), 359, 360f
Major hemorrhage packs, 74
Major hemorrhage protocols (MHP), 74
Major trauma centers (MTCs), 34
Mangled extremity
denition of, 255–256
lower, 307
management of, 344
Mangled Extremity Severity Score (MESS), 255,
256t, 275
Mangled Extremity Syndrome Index (MESI),
255, 256t
Massive, high-energy military lower extremity
trauma, 275, 275f
Mass shooting, 353
Matas, Rudolph, 396–398
Mattox maneuver, 341, 341f
Maxillofacial hemorrhage, 63–64, 64f
Maximal amplitude (MA), 76–77
MBHs. See Military base hospitals (MBHs)
McClean, Jay, 300
MDCT. See Multidetector computed tomography
(MDCT)
MDCTA. See Multidetector computed
tomographic angiography (MDCTA)
MDS. See Main dressing stations (MDS)
Mean arterial pressure (MAP), 75
Mechanism of injury, 82
in abdominal aortic trauma, 212–213
of cardiac, great vessel, and pulmonary
injuries, 3
upper extremity vascular injury, 252–253
Medial visceral rotation, 214
exposing inferior vena cava, 230f
left-sided, 215f, 216f
right-sided, 217f
Median sternotomy, 3, 10, 18, 18f
for zone I neck injuries, 336
Mesenteric arterial injuries, 297–298
Mesenteric venous systems, 226
Mesenteric vessels, intraluminal shunting of,
297–298
MESS. See Mangled Extremity Severity Score (MESS)
Military base hospitals (MBHs), 359–361
Military conict, vascular trauma and, 25–26
Military lower extremity injuries, 274, 274f
Minimal aortic injury (MAI), 209
Mitigating ischemic insult, 362
Modern ECLS, 163
MTCs. See Major trauma centers (MTCs)
Multidetector computed tomographic
angiography (MDCTA), for vascular
injury, 89
Multidetector computed tomography (MDCT),
101, 110, 378
Multiplanar degloving, 326–327, 326f
Multiple arterial injuries, 273
Mural hematoma, 273
Murphy, J.B., 15
Muscle aps, 345b
for lower limb wounds, 329
vascularized composite, for coverage of
vascular reconstruction, 345–347
Myocardial ischemia, 7
N
National Hospital of Sri Lanka (NHSL), 359
National Trauma Data Bank (NTDB), 26, 312
NCTH. See Noncompressible torso hemorrhage
(NCTH)
Neck
direct trauma to, 83
penetrating trauma of, 394
zones of, 243, 333–334, 334f
Neck injuries
in austere environment, vascular surgery for,
333–336
associated, 335
zone I, 336, 337f
zone III, 335–336, 336f
penetrating, 355
Neck outlet, vascular trauma to, 241
complications of, 248–250
indications of, 241–242, 243f, 247f
operative strategy and technique for, 243–248
outcomes of, 248–250
pitfalls and danger points in, 242–243
postoperative care for, 248–250
preoperative preparation for, 242
Neck vascular injuries, 59, 82–83, 85f
Negative pressure therapy, for upper extremity
vascular injury, 267
Negative pressure wound therapy (NPWT)
dressings, 327
Nelson, Horatio, 13
Nephropathy, contrast-induced, 93
Neurological decit, great vessel injuries and, 22
Neurologic decit
in carotid/vertebral injuries, 243
postoperative lateralizing, after carotid
reconstruction, 249
New Injury Severity Score (NISS), 56, 57f
New Zealand, vascular trauma in
access to care in, 353–354
considerations for diagnosis of, 354–355
epidemiology in, 353
prehospital care in, 354
strategies for sustaining and training of
trauma surgeons in, 356
surgical training and certication in, 353
systems of care in, 353
treatment strategies in, 355, 355f
Next generation of trauma surgeons, 405–406
N-methyl-D-aspartate (NMDA), 75
“No man’s land”, 357
Noncompressible torso hemorrhage (NCTH), 108
Noniatrogenic vascular injuries, 312
Non-terror-related vascular trauma (NVT), 388
Novel hybrid resuscitation, 66
NTDB. See National Trauma Data Bank (NTDB)
O
Obesity, vascular trauma and, 28–29
Occlusion balloons, for hemorrhage control,
230, 237
Occlusive injuries, 273
OIF. See Operation Iraqi Freedom (OIF)
On-table angiography, 398–400
Open exposure of proximal brachial artery,
367–368, 368f
Open fractures, grading of, 321, 322t
Open surgical exploration, 314–316, 315f
Open surgical repair, of blunt thoracic aortic
injury, 204–205, 205f
versus endovascular aortic, 208t
Open surgical subxyphoid pericardial window, 8
Open tibial fractures, 322t
Open tibial shaft fractures, limb salvage patients
with, 322
Operation Iraqi Freedom (OIF), 288–289
Operative hemorrhage control, 108
Optimal vascular conduit, problem identication
of, 300, 301f
Order of St John, 354
Organ injury scale, for abdominal vascular
injury, 227t
Orthopedic fractures, grading of, 322t
Orthopedic injury, 321
Ownership, in systemizing vascular-injury care,
38
Oxygen delivery, 76
P
Packed red blood cells (pRBC), 67
PAMPER, 74
“Panel graft”, 305
Parachute metaphor, 166
Paraplegia, 204
Paré, Ambroise, 12
Partial REBOA (P-REBOA), 133
Patch angioplasty, technique of, 300
Patient and limb outcomes, lower extremity
vascular injuries, 275–277
amputation, 275
functional outcomes and quality of life, 277
limb complications, 276
mortality, 275
Pediatric vascular anastomotic technique, 315f,
316, 316f
Pediatric vascular injury, 312
anatomic and physiologic considerations, 313
computed tomography angiography, 313,
314f
diagnosis and evaluation of, 313–314
diagnosis and management of, 312b, 313t
epidemiology of, 312–313, 314f
future directions, 318
postinjury surveillance and outcomes, 318
special situations, 317–318
brachial artery injuries, 318
compartment syndrome and fasciotomy,
318, 318f
extracorporeal membrane oxygenation
(ECMO), 317
supracondylar humerus fractures, 318
therapeutic approach, 314–317
anticoagulation, papaverine, thrombolysis,
and shunts, 317, 317f
cervical and torso vascular injuries, 316
endovascular options, 317
open surgical exploration, 314–316, 315f
pediatric vascular anastomotic technique,
315f, 316, 316f
repair of extremity vascular injuries,
314–316, 315f
Pediatric vascular trauma, 29, 383–385,
386f
Pelvic bleeding, 120–122
Pelvic hemorrhage, 63, 63b
Pelvic packing, 214
Pelvic trauma, endovascular treatment of, 223
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Penetrating injury, 212
to inferior vena cava, 228
neck injuries, 355
Penetrating trauma, 391, 392f
in abdominal vascular injuries, 212
in axillary artery injury, 260
to great vessels
diagnosis of, 17
etiology of, 14
incidence of, 13
presentation of, 14, 14f, 15f, 16f
to heart
diagnosis of, 7–9
incidence of, 5–7
presentation of, 7
in iliac artery injuries, 220
to lungs
etiology of, 23
incidence of, 22
of neck, 394
region-specic epidemiology of, 353
Pericardiocentesis, 7
Permanent embolization agents, 115–116
coils, 115–116
plugs, 116
thrombin, 115
Permissive hypotension, 65
Phrenic nerves, 243
Physical examination, in penetrating injuries,
241
Pirogov, Nikolai, 374
Plate xation, of open fractures, 327
Plugs, 116
Pneumonectomy, 26
Pneumothorax, 23
open, 23
tension, 23
Point-of-care ultrasound (POCUS), 99
Poly traumatized extremity, surgical
management of, 325–327
Polyvinyl alcohol (PVA), 115
Popliteal artery, 282–284, 283f, 284f
Popliteal artery injury, 397f
Popliteal fossa skin incision, 397f
Portal vein, injury to, 234–235, 234f
bleeding control in, 234–235
exposure and mobilization of, 234
ligation in, 235
repair of, 235
Positioning of balloon, for REBOA, 129–130,
130f, 130t
Posterior popliteal artery approach, 396–398,
397f, 398f
Potts vessel loops, 283
Poverty, vascular trauma and, 29
Predictive Salvage Index (PSI), 255
Prehospital care, for vascular injury, in Australia
and New Zealand, 354
Prehospital management, of vascular injury, 55
bleeding, 56–64
replacing lost volume, 64–67
Primary bleeding control, 377, 379f
Prophylactic fasciotomy
in austere environment, 344
ligation of vena cava and, 232
PROspective Observational Vascular Injury
Treatment (PROOVIT) registry, 212, 318
Prosthetic conduits, 301–302, 302f, 305t, 307
in austere and military settings, 307, 308f,
309f
triplex, 305
Proximal carotid artery injuries, 316
Proximal popliteal exposure, 283
Proximal vascular control, minimization of blood
loss and, 243
Pruitt F3 shunt, 292, 292t, 293f
Pseudoaneurysm, 91
abdominal vascular injuries and, 214
angiographic ndings in, 92t
ultrasound ndings in, 98t
Pulmonary artery, intrapericardial clamping
of, 25
Pulmonary contusion, supportive care after, 24
Pulmonary pseudocyst, 27
Pulmonotomy, 25–26, 26f
Pulse examination of, at wrist and foot, 86–87
Q
Quality improvement (QI), trauma, 35
R
Radial artery, anatomy of, 263, 264f
Radial artery ap, 349f
Radial artery injuries, 263–265
operative management of, 263–264, 264f
operative technique of, 265
Radial forearm ap, 346–347, 349f
Radiation, exposure to, from diagnostic CT scans,
104
RAPTOR suite, 367
REBOA. See Resuscitative endovascular balloon
occlusion of the aorta (REBOA)
Reconstruction
x and ap, 328
ap, 328–329
in soft tissue and skeletal wound
management, 327–330
choice and type of, 328
Rectus abdominus ap, 345, 346f
Referral trauma centers, 403
Regional perfusion optimization (REPO),
138–141, 139f, 140f, 141t
Regional trauma system, 34
Renal artery, injuries to, 219–220
Renal injury, 119–120
Renal replacement therapy (RRT), 158
Reperfusion injury, upper extremity, axillary or
subclavian artery repair and, 249
Residual distal thrombosis, 382
Resources for the Optimal Care of the Injured
Patient, 36
Responsibilities, in systemizing vascular-injury
care, 38
Resuscitation
ethics of, 77–78
thoracic aortic occlusion, history of, 126
Resuscitation strategies, 65–66
acute traumatic coagulopathy, 65–66, 65f,
66f
choice of uid, 66–67
novel hybrid resuscitation, 66
pharmacological adjuncts, 67
practical application, 66
transport destination, 67
Resuscitation strategy, 362
Resuscitative endovascular balloon occlusion of
the aorta (REBOA), 39–40, 51, 61, 137,
367, 367f, 393
clinical outcomes, 127
complications of
arterial access complications, 133–134, 133f
placement-related complications, 134, 134f
reperfusion complications, 134–135
extended applications of, 133
history of, 126
physiologic limitations, 126–127
problems with, 137–138, 138t
strategy to address limitations of, 137–138
technical aspects of
step-by-step placement, 128–131, 128b
tools and materials, 127–128, 127f, 128f
treatment, 131–132, 131f, 132f
Resuscitative thoracotomy (RT), 341–342
for vein injury, 228
Retrohepatic cava, injury to, 228
Retrohepatic inferior vena cava, 228, 229f
Retroperitoneal hematoma, in major vein injury,
228
Revascularization, for severely injured limb, 323
Reverse saphenous vein graft (RSVG), 362,
362f
Right common carotid artery repair, 249f
Ringer’ s lactate, for thoracic trauma, 4
Rotational thromboelastometry (ROTEM), 76
Royal Australasian College of Surgeons (RACS),
353
RSVG. See Reverse saphenous vein graft (RSVG)
R-Time, 76
Rufus of Ephesus, 12–13
Rural populations, vascular trauma in, 28
Rural setting, in Brazil, 401–402
Russia, vascular trauma in, 374
epidemiology of, 374
historical background, 374
next generation of trauma surgeons, 375–
376
specic considerations for diagnosis, 374–
375, 375t
specic systems of care, 374
specic treatment strategies, 375, 375f, 376f
S
SAAP. See Selective aortic arch perfusion (SAAP)
Saphenous fasciocutaneous ap, 347f
Saphenous vein
bypass, 300
in vascular repair, 343–344
Saphenous vein graft aneurysm, 386f
Scaffold free techniques, 308
Selective aortic arch perfusion (SAAP)
advantages, 152
description of, 144, 145f, 146f
in endovascular resuscitation, 154–156
laboratory animal studies, 152–154
in hemorrhage-induced traumatic cardiac
arrest, 153–154, 154f, 155f
in ventricular brillation cardiac arrest,
152–153, 153f
limitations, 152
rationale for
cardiac arrest survival, 144–145
limitations, 146–147
standard resuscitation, 146–147
sequential interventions, 149–152, 150f
catheter perfusion support, 151
with oxygenated autologous blood, 151
with oxygenated exogenous oxygen carrier,
149–151
transition from, 151
Self-expanding stents, 117
Serbia, vascular trauma in, 377
Serbinenko, Fedor, 374
Severely injured limb
strategies in managing of, 322–330
major limb amputation for trauma, 323, 324b
sequencing of interventions, 322–323
Shock packs, 74
Shock, subclavian artery injury and, 257
Shumacker, 396–398
414 Index
https://t.me/medicina_free
Shunts
Argyle, 292f, 292t, 293f
atriocaval, 237–238, 238f
Brener, 292t
Burbank, 292t
Javid, 290f, 292t
Pruitt F3, 291–292, 292t, 293f
straight, 292t
Sundt, 292t, 293f
temporary vascular. See Temporary vascular
shunts
temporary venous, 237
SIC. See Societé International de Chirugie (SIC)
Simulation-based training, for vascular trauma,
47–48
Skin staplers, disposable, 10
Slings, for upper extremity injuries, 339, 339f
Societé International de Chirugie (SIC), 48
Soft signs, of vascular injury, 86b, 333–334
Soft-tissue and skeletal wound management
assessment of injured extremity, 324–325,
325t
epidemiological factors of, 321
grading of open fractures, 321–322, 322t
initial surgical management in, 325–327
reconstruction in, 327–330
salvage versus amputation, 322
in setting of vascular injury, 321
strategies in managing severely injured limb,
322–330
Soft tissue, coverage of repair with, 327, 328f
Soft-tissue injury, in austere environment,
vascular surgery for, 344–347, 345b
Soleus muscle aps, 345, 346f
Solid organ injury, management of, 117–120,
118t
liver, 119
postintervention, 120
renal, 119–120
splenic injury, 117–119
Solid organs, trauma in, endovascular treatment
of, 223, 224f
Soubbotich, Vojislav, 377
South Africa, vascular trauma in, 391
considerations for diagnosis of, 393–394,
394f
epidemiology of, 391–392, 392f
strategies for sustaining and training of
trauma surgeons in, 395
systems of care in, 392–393
treatment strategies for, 394–395
Soviet War in Afghanistan (SWA), 374–375
Specialty advisory committees (SACs), 44
Spiral vein graft, for inferior vena cava repair,
233, 233f
Splenic angioembolization (SAE), 117
Splenic artery, injuries to, 218
Splenic injury, 117–119
Sri Lanka College of Military Medicine
(SLCOMM), 363
Sri Lanka Medical Corps, 358
Sri Lanka, vascular injuries in, 357
considerations for diagnosis, 359–360
epidemiology of wartime injury, 357–358
combat-related geography, terrain, and
weather, 357, 358f
demographics, 358, 359f
war tactics and weapons, 357–358
sustaining and training the next generation,
363–364
challenges, 363
general strategies, 363
military-related strategies, 363
system of care, 358–359
administrative structure, 359
medical, 359, 360f
treatment strategies, 360–363
complications, 363
concomitant injuries, 363
denitive vascular reconstruction, 362
hemorrhage control, 360–361, 361f
managing infections, 362–363
mitigating ischemic insult, 362
resuscitation strategy, 362
Stabilization of bony pelvis, 223
Stab wounds, in abdominal vascular injuries,
212
Stapled wedge resection, 25
Stenosis, arterial
angiographic ndings in, 92t
ultrasound ndings in, 98t
Stents-grafts, 116–117, 237
balloon-expanding stents, 116–117
self-expanding stents, 117
Sternotomy, limited, for zone I neck injuries, 336
Straight shunt, 292t
Stryker Pressure Monitor™, 89–90, 89f
Styptics, in initial control of hemorrhage, 12
Subclavian artery
anatomy of, 257, 257f
blunt thoracic aortic injury in, 200f, 207,
208f
blunt trauma to, 14
injuries to, 256–257
endovascular repair of, 248
operative management of, 257–259, 258f,
259f
repair of, 249
operative strategy and technique for,
247–248, 248f
surgical treatment of, 247
Subclavian injuries, 404, 405f
Subclavian vessels, right and left, 21
Sundt shunt, 292t, 293f
Supercial femoral artery (SFA), 273, 282
Superior mesenteric artery (SMA), injury to,
218–219, 219f
Fullen’s classication of, 219t
Superior mesenteric vein, injuries to, 235–236
bleeding control in, 236
exposure and mobilization of, 235–236, 236f
ligation in, 236
repair of, 236
Superior vena cava, injuries to, vascular repair
of, 21
Supracondylar fracture, brachial artery injury
and, 261
Supracondylar humerus fractures, 318
Suprahepatic inferior vena cava, 229, 229f
Suprarenal inferior vena cava, 229, 229f
Surgical anatomy, in inferior vena cava injuries,
229, 229f
Surgical Council on Resident Education (SCORE),
42–43
Surgical damage control, 288
Surgical débridement, of injured tissues, 325–326
Surgical innovation
complex interventions, 166–167
stages of, 167, 167t
Surgical techniques, for abdominal aortic
trauma, 214–216
Surgical treatment, facilitating, 77
Suture pneumonorrhaphy, 25
Suture repair, 10
factors for, 4
Sweden, vascular trauma in, 370–372
education in vascular trauma, 373
endovascular resuscitation and trauma
management (EVTM), 372–373
new developments, 372–373
Swedish trauma system, 370, 371f
trauma and vascular registries, 370
trauma in Sweden, 370–371, 371f
Swedish trauma and vascular registries, 370
Swedish trauma system, 371f
Syringe suction bottle, 335f
Systems of care
in Australia and New Zealand, 353
in South Africa, 392–393
in vascular injury management, 34
clinical practice guidelines in, 39
community outreach, 40
data collection and comparison in, 38–39,
39b
key components of, 34–35
ownership and responsibilities in, 38
point of injury therapy, 40
REBOA, 39–40
tracking of new technology in, 39
trauma center function in, 35–36
whole blood, 40
T
Teaching Hospital Anuradhapura (THA), 357
Team-based training, for vascular trauma,
46–47
Technology, new, in systemizing vascular-injury
care, 39
Teon pledgets, 10
Temporary embolization agents, 114–115
Temporary shunting, vascular, for severely
injured limb, 323
Temporary vascular shunts, 288, 317, 317f, 339
anatomic location in, 295
dwell time of, 295
indications of, 289–290, 291b
insertion technique of, 292–295, 294f
materials for, 290–292, 292f, 293f
for multiply-injured patient, 288
for reestablishment of circulation, 325
removal technique of, 293–295
special considerations in, 295–298
types of, 292t, 293f
in upper extremity vascular injury, 255, 255f
vascular branch points in, 297
Temporary venous shunts, 237
Terror-related vascular trauma (TVT), 388–389
TEVAR. See Thoracic endovascular aortic repair
(TEVAR)
Thoracic aorta, penetrating injury to, 304
Thoracic aortic injury, blunt, 199
Thoracic aortic occlusion, history of,
resuscitation, 126
Thoracic aortic stent-grafts, aortogram of, 355f
Thoracic endovascular aortic repair (TEVAR), 94
Thoracic hemorrhage, 62
Thoracic injuries, vascular conduit for, 304
Thoracic outlet, vascular trauma to, 241
complications of, 248–250
indications of, 241–242, 243f, 247f
operative strategy and technique for, 243–
248
outcomes of, 248–250
pitfalls and danger points in, 242–243
postoperative care for, 248–250
preoperative preparation for, 242
Thoracic spine, fracture of, 83
Thoracic vascular injuries, 83, 85f
Thoracic vascular trauma, 405
Thoracotomy (RT), 61
Thoracotomy, resuscitative, for vein injury, 228
3-D resuscitation, 72
Thrombin, 115
Thromboelastography (TEG), 76, 77f
Thrombophilia, 99
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