Some wounds are so deadly that the patient may lose his/her life if the surgery gets delayed.

Today, in this article, you’ll learn about such vascular injuries or traumas, which require immediate surgery.

What is Vascular Injury?

The term Vascular Injury refers to an injury of artery(blood vessel carrying blood to limbs from heart) or vein (blood vessel carrying blood back to heart from the limbs).

They play a vital role in the human body. 

Vascular traumas are dangerous, and if left untreated for a longer period, they can be fatal. These injuries can cause gangrene of the affected limb and, if further ignored, can become life threatening as well.

What causes vascular injury?

Numerous factors can be responsible for vascular injury. 

Penetrating wounds cause Vascular injuries. Penetrating trauma refers to injuries or damages caused by an object that penetrates the skin, such as a gunshot, stabbing wound, or a deep wound caused by sharp objects like a knife, broken glass, etc. However, the majority of vascular injuries occur due to severe accidents such as car accidents, falls, athletic injuries, violent crimes, bomb blast.

Symptoms of Vascular Injury

Here, are some common symptoms of Vascular injury-

  • Heavy blood loss
  • Fractured bones
  • Bruising
  • Swelling
  • Severe pain distal to the point of injury (ex severe pain in the foot when there is a significant injury in the knee)
  • Cold extremities
  • Pulse is usually absent distal to the injury
  • There may be numbness and / or weakness
  • On evaluation of oxygen saturation, there may be no waveforms and it may be 0% or significantly less than 100%.

Diagnosis

Vascular injuries can be diagnosed by several invasive and noninvasive tests.

Invasive tests

  • Angiography
  • DSA (Digital Subtraction Angiography)
  • MRA (Magnetic Resonance Angiography)
  • Venography

Noninvasive tests

  • Duplex ultrasound
  • B-mode ultrasound
  • Doppler ultrasound (colour flow)
  • Handheld doppler
  • CT Scanning.
  • Ankle Brachial Index (ABI)

Emergency surgery for vascular injury

Vascular trauma can be mild, moderate, or severe. Some vascular lesions go away on their own after a long period of time, while some severe instances require immediate surgery. 

Major vascular traumas should be treated within 6-8 hours, and if the patient does not get treatment promptly, the patient may lose his life or limb.

Here are some of the vascular trauma that requires emergency surgery.

Peripheral vascular injury

The peripheral vascular injury refers to the damages that occurred in the main arteries and veins due to which the arteries and veins are not able to supply oxygen-rich blood to a particular body part, and this can be resulting in loss of limb or life.

If treatment is not given immediately, then the arteries and veins can get damaged permanently, or the patient may go into sepsis because of gangrene of the limb, which can be life threatening.

Thoracic aorta injury

Thoracic aorta injury refers to the damage caused in the aorta artery, which lies in the chest cavity. Mostly, it is caused due to accidents or penetrating trauma.

It is difficult to diagnose it clinically and one has to have a high index of suspicion.

Vascular Spasm

In vascular spasm, the blood vessels suddenly get tightened and cause intense pain.

The tightening of the blood vessel reduces the blood flow, and sometimes it completely restricts the flow of blood. When the oxygenated blood doesn’t reach its targeted area, the tissues of that area get affected.

Intimal flap

Any severe blunt trauma can lead to intimal flap or wall defect in an artery.

The lesion requires immediate surgical resection or more commonly, may need angioplasty and/or stenting.

Arteriovenous fistula (A-V fistula)

An arteriovenous fistula is an unusual connection between an artery and a vein.

Normally, blood flows from arteries to capillaries, and then blood reaches in the veins, but in Arteriovenous fistula condition, the blood directly flows in the veins from the arteries. So, in this condition, the capillaries receive very little blood. 

This condition can develop anywhere in the body, but mostly it occurs in the legs.

Aneurysm

Aneurysm refers to the condition when an artery gets enlarged due to weakening or bulging in the artery wall. 

A ruptured aneurysm is fatal, and if an aneurysm gets ruptured before treatment, there is a high chance that patients will lose their life.

They don’t show any early signs & symptoms. Rupture causes severe pain and hypotension (low blood pressure). Cases of aortic aneurysm rupture can hardly ever reach the hospital. Even in those cases, which can reach the hospital alive, success rate is very low.

An aneurysm can affect any artery, but it mostly affects the body’s main artery in the abdomen (Abdominal aorta).

Pseudoaneurysm

Pseudoaneurysms refer to the accumulation of blood between two outer layers of an artery.

Blood begins to accumulate when the walls of an artery are injured, and the blood starts leaking.

If it is left untreated, it can lead to more severe conditions such as clot development and migration of clot to finger / toes / intestines / brain and respective symptoms. Also, these pseudoaneurysms can get ruptured and can cause grave threat to life and limb. 

Arterial embolism

Arterial embolism refers to a condition in which blood flow suddenly gets disrupted due to an embolus (blood clot).

Blood clots generally occur in the legs, arms or feet.

Several factors can be responsible for the development of embolism, such as hypertension, smoking, heart disease, any injury or surgery of the artery.

These are some vascular injuries that need to be treated as soon as possible to prevent any permanent damage, loss of limb, loss of life. The most important thing to realize in case of vascular injuries is that the main thing that saves the limb and the life of the patient is immediate correction of vascular surgery. The early we operate on a needy patient, better are the results.

Also, overall, if we operate upon a patient in time, the results are excellent because, usually, these patients donot have any underlying vascular surgery disease and they respond very well to treatment.

Therefore, proper intervention by a qualified vascular surgeon which is done within the golden hours can be the difference between limb salvage and loss of limb.