Endovascular Management of Peripheral Vascular Trauma

Abstract

Endovascular interventions (EVIs) are an important adjunct to open surgical management of peripheral vascular injuries. In appropriate situations, EVIs decrease operative time, estimated blood loss, and iatrogenic complications when compared with similar surgical cohorts by limiting surgical dissection in traumatized operative fields. In situations where definitive repair is not possible with EVIs, endovascular techniques permit control of hemorrhage or damage and facilitate open surgical repair. EVIs for peripheral vascular injury have proven effective in three anatomic regions: the neck, subclavian, and lower-extremity regions. The interventional radiologist should become familiar with the physical and personnel resources in the area preferred by the consulting trauma team to minimize unnecessary delays when acute intervention or angiography is requested. Clinical and radiographic surveillance for patency and compliance with antiplatelet or anticoagulation therapy is essential but has historically been poor in trauma patients.

Emergency vascular injuries: patient profile, management strategies and risk factors for mortality

“…[11] Patients with injuries in an anatomic region where surgical exposure is difficult and with an increased risk for iatrogenic injuries during the exposure are ideal candidates for endovascular interventions. [11] Endovascular interventions have been suggested to reduce operating room time, estimated blood loss, and iatrogenic injury in trauma cases, while increasing operating costs, compared to open surgery.…”

“…[11] Patients with injuries in an anatomic region where surgical exposure is difficult and with an increased risk for iatrogenic injuries during the exposure are ideal candidates for endovascular interventions. [11] Endovascular interventions have been suggested to reduce operating room time, estimated blood loss, and iatrogenic injury in trauma cases, while increasing operating costs, compared to open surgery. [12,13] The major uses of endovascular techniques for trauma are bleeding control interventions such as balloon occlusion, embolization, and deployment of a covered stent, exclusion of pseudoaneurysms and arteriovenous fistulas by either covered stents or coil embolization, and deployment of bare metal stents or covered stents for dissection.…”

“…[12,13] The major uses of endovascular techniques for trauma are bleeding control interventions such as balloon occlusion, embolization, and deployment of a covered stent, exclusion of pseudoaneurysms and arteriovenous fistulas by either covered stents or coil embolization, and deployment of bare metal stents or covered stents for dissection. [11,[14][15][16] In our daily practice, we have been using endovascular interventions increasingly for our elective cases; however, due to the lack of endovascular capabilities in the operating room, the number of emergency cases treated with this modality still remains low. In the present study, only one patient was treated with an endograft for ruptured subclavian artery, and one other patient underwent thoracic endovascular graft implantation, [17] although our number has been increasing since that time.…”

Difficulties in the Management of Civilian Peripheral Vascular Trauma and their Complications at the University Teaching Hospital of Yaoundé, Cameroon

“…If endovascular techniques (embolization, stenting) are widely used in the Western world for some vascular injuries [18], open surgery keeps a place of choice for many authors with good results [6][7][8][9]. However, endovascular techniques in properly selected patients offer many advantages.…”

“…They reduce operating time and blood loss, limit dissection of bruised or injured tissues by the initial trauma and allow access to hard-to-reach areas with good safety and acceptable efficiency [10]. In cases where the final repair is not possible, they allow control of bleeding or damage and facilitate the surgical procedure [18].…”