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Traumatic vascular injuries are uncommon but lethal. Although they may occur after significant blunt trauma, the majority of traumatic vascular injuries are seen after a penetrating mechanism. Vascular trauma may result in arterial, venous, or combined injuries and can be managed with an open, endovascular, or nonoperative approach. Regardless of the approach, patients with vascular trauma are at high risk for both local and systemic complications, and these complications may occur in an acute or delayed fashion. This chapter will review the risk factors, diagnosis, and management of complications after traumatic vascular injury.
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SYSTEMIC COMPLICATIONS
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Despite advances in techniques and management of vascular injuries, mortality is still significant following vascular trauma. Proponents of endovascular repair recommend this approach whenever feasible with the hopes of reducing mortality; however, in many analyses, the rates of death following endovascular repair of vascular injuries have been found to be similar to open approaches.1 This is in part due to the fact that regardless of the approach, mortality is often caused by associated injuries or multisystem organ failure and is not a result of the vascular injury or the procedure itself. Overall, patients with traumatic vascular injury who undergo surgical or endovascular repair will have more increased overall mortality than those who do not. This is understandable, as these patients are often more severely injured and may require numerous complex interventions.
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The anatomic location of the vascular trauma plays a significant role in mortality. Patients with aortic rupture and major trauma to their great vessels are often pronounced deceased at the scene and do not make it to the hospital. Those who do undergo emergent repair have high rates of morbidity and mortality. Vascular injuries to the head and neck although not immediately lethal have mortality rates ranging from 23% to 28%. Vascular injuries of the extremities can result in significant hemorrhage; however, the use of prehospital tourniquets can lead to improved outcomes and decreased mortality.2 Vascular injuries leading to intra-abdominal or retroperitoneal bleeding cannot be controlled in the prehospital setting and can be a technical challenge in the operating room, leading to an increased in-hospital mortality as well.3
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Stroke and Neurologic Defects
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Vascular injuries posing the greatest risk for stroke and neurologic deficits are injuries to the carotid or vertebral arteries. These injuries, together with named blunt cerebrovascular injuries (BCVIs), account for 0.33% to 1% of all blunt traumatic injuries. BCVI complications can range from minimal outcome significance to debilitating stroke. Of the patients who do survive their injuries, 48% to 58% will have some form of permanent neurologic deficit.
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Stroke after BCVIs has a variable incidence based on location of injury: internal carotid (13% to 21%), common carotid (11%), and vertebral (14% to 24%). While stroke and neurologic deficit incidence are independent of ...