WSES position paper on vascular emergency surgery

Abstract

Trauma, both blunt and penetrating, is extremely common worldwide, as trauma to major vessels. The management of these patients requires specialized surgical skills and techniques of the trauma surgeon. Furthermore few other surgical emergencies require immediate diagnosis and treatment like a ruptured abdominal aortic aneurysm (rAAA). Mortality of patients with a rAAA reaches 85 %, with more than half dying before reaching the hospital. These are acute events demanding immediate intervention to save life and limb and precluding any attempt at transfer or referral.It is the purpose of this position paper to discuss neck, chest, extremities and abdominal trauma, bringing to light recent evidence based data as well as expert opinions; besides, in this paper we present a review of the recent literature on rAAA and we discuss the rationale for transfer to referral center, the role of preoperative imaging and the pros and cons of Endoluminal repair of rAAA (REVAR) versus Open Repair (OR).

Iatrogenic Vascular Injuries in Resource-Limited Setting: A 4-Year Experience Monocentric Retrospective Study

“…Indeed, such an approach requires exceptional precision to avert complications like tension or stenosis, particularly when end-to-end anastomosis is considered. 27 Corroborating our findings, a similar study reported that primary repair was the most frequently utilized surgical procedure in 65% of patients, with end-to-end anastomosis and saphenous vein graft interposition applied in 44% and 38% of cases, respectively. 28 Additionally, a previous study recommended saphenous vein graft interposition as the most effective surgical intervention for injuries to the superficial femoral artery.…”

Toracotomia de reanimação e novas alternativas invasivas para reanimação do paciente politraumatizado grave

“…Adicionalmente massagem cardíaca, vigorosa pode promover dissolução de ar já presente nas artérias coronárias. A aspiração da raiz da aorta é feita para evacuar qualquer bolsa de ar acumulada (31).…”

“…Quando for necessário a visualização de ferimentos penetrantes no arco aórtico ou ramos principais da aorta, esternotomia mediana pode ser necessária e nos caos de lesão do arco aórtico, circulação extra-corpórea deve estar pronta para utilização (31). Na ocasião do esterno ser dividido transversalmente, os vasos torácicos internos devem ser ligados quando a perfusão for restaurada; isto pode ser realizado utilizando-se um ponto em "X" com seda ou algodão 2-0.…”

Short version of the S3 guideline on screening, diagnosis, therapy and follow-up of abdominal aortic aneurysms

“…The permissive hypotension concept aims to reduce the fluid supply in rAAA patients with shock, since massive fluid delivery leads to hemodilution, adversely affecting oxygenation, blood clotting, bleeding due to increased pressure, and thrombus detachment. The aim of preprocedural shock treatment is to provide only enough fluids to maintain a conscious patient, prevent ST changes in the ECG, and maintain the systolic blood pressure at 70-80 mm Hg [42] until surgical control of the bleeding is assured; however, the concept of preprocedural permissive hypotension in patients with rAAA (a patient clientele with high cardiovascular morbidity) is not clearly established. No randomized trials pertaining to this concept could be found in a Cochrane review, leaving the question open as to benefits for rAAA patients [92].…”