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Trauma & the Vascular System: An Unfortunate, Controllable Duo
Omar P. Haqqani, MD
Midland Daily News
March 12, 2017
Injury to a blood vessel through trauma can be a devastating occurrence and requires the expeditious involvement of a vascular surgeon.
Major trauma is what can result in damage to the vascular system, depending on the area where the injury takes place, as well as its severity.
Major trauma can occur in many different ways, including wounds by gunshot, car accidents, stabbing, or falls. Whenever an instance of trauma occurs, regardless of the severity, medical attention from a trauma center should be immediately sought out in order to assess the victims' injuries.
Blunt and penetrating trauma can both be responsible for complications associated with vascular health – blunt trauma refers to injury caused by direct impact, while penetrating trauma is an injury where the object impales and enters the body, resulting in an open wound.
Blast injury is the combination of these two types of trauma, and is usually also accompanied by a burn injury.
In instances of trauma, diagnosis of the injury is typically done through one of two processes.
Physical examination is done in instances of life or death injuries, with an initial examination done to identify the problem, and a second examination to systemically assess if the injury affected other areas of the body, such as the abdominal, pelvic, and thoracic regions.
Imaging processes may also be used to identify the severity of the injury – x-rays are often used for examining the chest and pelvic regions, and focused assessment with sonography for trauma (FAST) can be used to check internal bleeding, depending on the mechanism and presentation of injury.
Additionally, surgical techniques can be used in cases of chest or abdominal trauma, specifically when victims are affected by shock.
Vascular trauma occurs when a blood vessel is injured through either instance, be it blunt or penetrating.
Blunt trauma is generally managed through supportive measures. Penetrating trauma however such as gunshot wounds can destroy blood vessels, which require expeditious surgical repair. As the blood vessel is transected the area beyond the injury will not receive blood flow, which can compromise the tissue such as a leg, arm or other organ. Evaluation and reconstruction of the injured blood vessel can be performed using the patient’s own “extra” veins or artificial blood vessels.
When suspected vascular trauma occurs, diagnosis rests primarily on a physical examination. In most cases, hard signs of vascular injury dictates whether immediate action is necessary; Basically, if severe injuries are visible, then urgent medical assistance should be sought out.
Some hard signs of vascular injury include tangible thrill in the injured region, turbulent blood flow, a cold, whitish limb, a lack of a consistent pulse, and expanding haematoma. If any of these signs are present, operative intervention is imperative.
Alternatively, soft signs of vascular injury should also be a cause for concern, though the presence of only soft signs does not warrant immediate medical assistance.
Potential soft signs of vascular injury include a reduced, but consistent pulse around the site of injury near a major artery, peripheral nerve discrepancy, or moderate hemorrhaging.
When treated for trauma as a result of vascular injuries, multiple tests are available to determine the injury’s severity.
Ultrasound is often used, in two different forms of testing: Doppler ultrasound is used to locate the presence of a pulse, whether absent or visible, and duplex ultrasound uses b-mode and Doppler ultrasound to pinpoint tears, false aneurysms, or thrombosis around the site of injury.
Additionally, angiography, typically used in the operating room, can be used to help treat the most traumatic cases of injury through exposure of the injury’s closest blood vessel for better surgical control.
In my own experience, vascular procedures for trauma are highly complicated and in the Mid-Michigan region are not always related to gunshot wounds but rather on the job hazards.
I have personally taken care of patients who have had injury to their blood vessels because of construction materials that “cut” through important blood vessels or high-speed motor vehicle accidents that affect the large blood vessels in the chest.
My experience has dictated that urgent evaluation and treatment is the cornerstone to saving limbs and life.
While the types and severity of trauma often differ depending on the incident and condition where injuries were brought on, it’s still important to recognize how specific types of traumatic injuries can affect vascular health.
Though there isn’t one single solution to dealing with the major effects of traumatic injuries, there are many options that can help patients overcome their particular condition, and attempt to find normalcy in their daily life once again.
Dr. Omar P. Haqqani is the chief of Vascular and Endovascular Surgery at Vascular Health Clinics in Midland.
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