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Chapter-13 Management of Vascular Injuries

BOOK TITLE: Recent Advances in Surgery 33

Author
1. Tambyraja Andrew L
2. Chalmers Roderick TA
ISBN
9789380704227
DOI
10.5005/jp/books/11221_13
Edition
1/e
Publishing Year
2010
Pages
11
Author Affiliations
1. Royal Infirmary of Edinburgh and University of Edinburgh, UK
2. Royal Infirmary of Edinburgh and University of Edinburgh, UK
Chapter keywords

Abstract

Vascular trauma will continue to challenge surgeons. However, recent advances have armed surgeons with new strategies to investigate and treat such injured patients. The effectiveness and application of these measures is often dependent upon a cohesive, multidisciplinary approach involving a team of emergency medicine physicians, interventional radiologists, anesthetists and vascular surgeons. The relationship between hospital and surgeon volume and patient outcomes is increasingly recognized and it is important that patients are managed in centers with a contemporary infrastructure and appropriate levels of on-site expertise wherever possible. It is important to recognize that an endovascular solution in arterial injuries is achievable in around 10% of all cases treated. There is evidence to suggest that endovascular interventions are associated with shorter hospital stays and improved survival. The lethal triad of hypothermia, acidosis and coagulopathy should be avoided in patients with vascular injuries. Coagulopathy should be treated aggressively with blood products and supported by near patient testing wherever possible. Permissive hypotension can reduce blood loss and improve coagulation profiles. MDCT is increasingly used as a first line radiological investigation in the assessment of trauma. Endovascular techniques provide a useful therapeutic modality in the temporary and definitive management of some vascular injuries.

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