Overview of Vascular Trauma

Penetrating trauma to the neck is divided by zones, and involvement of the common carotid or internal carotid arteries can lead to stroke and death; blunt cerebrovascular trauma affects less than 1 % of all blunt trauma patients but can lead to a high rate of stroke and death as penetrating trauma. Optimal management of these injuries depends on the extent of injury and the vessel that is affected, and both open surgical and endovascular options are available. Penetrating trauma to the thoracic vasculature is rapidly fatal in most circumstances; blunt trauma to the arch and descending aorta is increasingly managed using intravascular ultrasound and endovascular stent graft placement. Major abdominal trauma is found in one in seven patients with a gunshot wound to the abdomen, and a variety of open and endovascular techniques can be used to treat the injury depending on the particular site and overall patient condition. Peripheral artery trauma can often be treated with placement of a covered stent or a bypass using autogenous conduit. Venous trauma is often more difficult to manage due to difficulty with exposure and extent of dissection necessary to achieve proximal and distal control, and simple ligation is often the most appropriate course of action in damage control surgery. An appreciation of the overall management of a variety of arterial and venous injuries may help guide the overall care of the polytrauma patient in a multidisciplinary environment.