Vascular Trauma

Vascular trauma can follow an accident, fracture, penetrating injury or medical procedure. Rapid recognition is important when blood flow to a limb is threatened or bleeding is ongoing.

Common findings may include active or expanding bleeding, cold, pale or numb limb, weak or absent pulse, expanding swelling after injury. Symptoms vary, and some people have advanced disease without a typical presentation.

Vascular trauma can result from road accidents, fractures, dislocations, penetrating wounds, crush injury or complications of a medical procedure. An artery may be cut, bruised, stretched, clotted or develop a pseudoaneurysm; veins can also bleed or thrombose.

High-energy limb injury, wounds near major vessels, severe fractures, expanding swelling, previous vascular repair and anticoagulant use increase concern. A normal-looking skin wound does not always exclude deeper arterial damage.

Evaluation may include emergency vascular examination, doppler assessment, ct angiography when time allows, assessment of associated bone and soft-tissue injury. The exact test is selected after reviewing symptoms, medical history and the vascular examination.

Ongoing bleeding can cause shock, while interrupted arterial flow can rapidly damage nerves and muscles and threaten the limb. Delayed problems include pseudoaneurysm, arteriovenous fistula, clotting and infection. Time-sensitive injuries require emergency care, not an elective clinic appointment.

For external bleeding, apply firm direct pressure and call emergency services. Do not remove an embedded object or use an improvised tourniquet unless trained and instructed. After repair, follow wound, medicine and vascular-surveillance instructions closely.

Depending on the diagnosis, options may include bleeding control and resuscitation, open vascular repair, endovascular treatment in selected injuries, fasciotomy or limb-salvage procedures when needed. A matching symptom does not automatically make a person suitable for a particular procedure.

Suspected vascular trauma is an emergency. Go to the nearest emergency department immediately.

Stable patients with a delayed pulsatile swelling, bruit or symptoms after injury should bring accident records, operative notes and imaging. Examination, Doppler and CT angiography help define whether surveillance, endovascular treatment or open repair is needed. Also bring a current medicine list and any relevant discharge or procedure records.