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Management of vascular injuries 

Management of vascular injuries
Chapter:
Management of vascular injuries
Author(s):

Ramyar Gilani

and Kenneth L. Mattox

DOI:
10.1093/med/9780199600830.003.0335
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date: 29 November 2020

Management of vascular injuries presents a unique set of challenges. Vascular injuries are commonly accompanied by injuries to other organ systems, and affected patients may be critically ill and close to the limits of their physiological reserve. Complications of vascular injury are bleeding, leading to hypovolaemic shock and consumptive coagulopathy, and vascular occlusion causing distal ischaemia and acidosis. When the patient’s clinical condition allows the diagnosis of vascular injuries relies on computerized tomographic angiography or digital subtraction angiography. Control of haemorrhage can be achieved with direct manual pressure, tourniquets for life-threatening extremity haemorrhage, or temporary occlusion with a balloon catheter. Simple surgical repairs may be performed. Ligation is quite well tolerated for arteries of distribution. For patients with significant or ongoing bleeding, a transfusion strategy using a 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets is currently considered the best strategy. For more stable patients, complex and definitive vascular repairs can be considered.

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