Vascular Trauma - Types, Diagnosis, and Treatment

What Is Vascular Trauma?

An injury or blow can cause harm to the vein or the artery, which is known as a vascular injury. The lower limbs are the most affected and can affect the arterial, lymphatic, or venous system. They are normally related to injuries to a limb or to joints affected by osteoarthritis. The most commonly seen clinical signs are hemorrhage (bleeding) or acute ischemia (lack of oxygen supply). This condition requires early detection as well as treatment to prevent any complications leading to the amputation of the limbs and to improve the prognosis of the condition.

Vascular injuries can be divided into two, and they are:

• Penetrating Trauma- This kind of injury is caused when a foreign object pierces or crushes the skin, which can result in the rupture of the blood vessel, causing hemorrhage or clotting.

• Non-penetrating Trauma- In this type of injury, there is no piercing; instead, there is tissue compression or sudden deceleration due to which the vessel wall break results in tearing and thrombosis.

What Are the Symptoms of Vascular Trauma?

Vascular trauma can show various symptoms like external hemorrhage and internal hemorrhage. Some vessel injuries can show ischemic symptoms. The symptoms of vascular injury are categorized as serious or non-serious symptoms, and they are:

Serious symptoms include:

• Active hemorrhage and absence of a distal pulse.

• Acute ischemia.

• Pulsating hematoma.

• The murmur of the heart.

Less serious symptoms include:

• Decreased in the distal pulse.

• Injury near an important blood vessel.

• Shock due to massive fluid loss.

• High blood pressure.

• Neurological defects affecting physical and intellectual abilities.

The most penetrating vascular injuries may be related to the esophagus, bronchus, heart, and trachea and are seen in surgeries. Most penetrating wounds should be explored surgically, and delaying this can even be fatal. In limb injuries, the most common type of vascular injury can be from acute ischemia, puncture wounds, injuries like dislocations, and fractures or low-velocity projectiles. Also, the chances of external hemorrhage are less.

What Causes Vascular Trauma?

The most common causes of vascular trauma are:

• Car and motorcycle accidents.

• Falls.

• Accidents in the home.

• Injuries during sports.

• Violent injuries from fights such as stab wounds and gunshot wounds.

How Is Vascular Trauma Diagnosed?

To diagnose vascular injury, the healthcare provider will examine the patient physically to check for vascular lesions. The doctor will look for the following:

• The general state of the patient.

• Location of the injury.

• Degree of hemodynamic stability.

• Bone or joint injuries.

• Presence of hemorrhage or ischemia.

• Color and temperature change around the injured site.

• Motor and sensory response.

• Heart murmurs.

• Pulsating tumors near the injury.

Apart from the physical examinations, the doctor will suggest some diagnostic tests which will help to find any hidden injuries and also to know the best way to treat them surgically. They are:

• Non-Invasive Vascular Tests - In patients whom it is difficult to examine due to edema or open injuries, non-invasive tests like the Doppler ultrasound are done to rule out arterial damage that is not visible and confirm the arterial permeability.

• X-ray - An X-ray of the chest or the limbs is done to see the extent of the vascular injury.

• Computerized Angiotomography - This is helpful in the early diagnosis of cervical, abdominal, and thoracic injuries.

• Arteriography - This is the standard test for diagnosing vascular injuries. It will help to know the location and the extent of the injury. It can also work as an access and to control the damaged vessels.

How Is Vascular Trauma Treated?

There are various methods to treat vascular trauma, and they are discussed below:

1) Surgical Repair:

Surgical repair of a blood vessel will mostly require a surgical bypass.

• In this procedure, an artificial or natural graft formed from a portion of the vein is taken from another part of the body (from the thighs or calf).

• Apart from repairing with a graft, if the injury is to the veins, then it can be treated by ligating.

2) Endovascular Treatment:

This method is minimally invasive compared to open surgery.

• In some cases, the injured vessel can be opened using balloon stenting to restore blood flow.

• A stent graft can also be placed during the same procedure to provide internal support to keep the vessel open.

3) Fasciotomy:

Fasciotomy is a surgical procedure done to repair muscle damage.

• In some injuries, the muscles can suffer due to improper blood circulation resulting from the vascular injury. There can be significant swelling when the legs are injured. In severe cases, the swollen muscles can even be constrained by the thick layer of tissue beneath the skin called the fascia. There can even be nerve damage resulting from the loss of blood supply to the muscle.

• In such conditions, the fascia is opened by incision so that the swelling does not exert much pressure on the small vessels and the nerves.

• Also, if the swelling is very much, the skin must be left open for several days and can be closed when the swelling resolves.

How Can One Reduce the Risk of Vascular Trauma?

• Wear seat belts while driving or traveling in a motorized vehicle.

• Do not drive while intoxicated or ride with an intoxicated driver.

• Handle sharp tools with care.

• Be careful while operating any machinery.

• Walk with caution through wet and slippery falls, stairs, and ladders.

• Avoid volatile situations and environments.

What Are the Complications of Vascular Trauma?

Vascular trauma can lead to several complications, and they are:

• Loss of blood, sometimes a large amount.

• Formation of thrombus (blood clot).

• Bruising and swelling.

• Soreness.

• Pain.

• Formation of the scar.

Scarring or incomplete healing can result in permanent weakness of the vessels, like the arteries and veins, making them more prone to injuries. When clots are formed they can block the blood flow, and they can be dangerous when the clots are dislodged from their original site and travel to other parts of the body like the heart, lungs, or brain.

Conclusion

Vascular trauma can occur during an accident or in other injuries. They can be either penetrating injuries or non-penetrating injuries. Care should be taken to manage such injuries. If the blood loss is severe then if required take the patient to the hospital before any complications occur.