Key points

• Remember the whole patient, do not just focus on the vascular injury

• Time is of the essence, avoid delay

• Do not attempt to mobilise large veins, use local pressure

• Consider temporary intravascular shunts in complex limb injuries

• Consider damage limitation surgery in patients developing hypothermia or acidosis

Trauma is a leading cause of mortality in the first four decades of life. Vascular surgeons are often involved in the management of a multiply-injured patient who may have limb- and/or life-threatening vascular injuries. In addition the extended range of procedures carried out by open and minimally invasive surgical and radiological techniques has created its own unique set of vascular injuries. It is beyond the scope of this short chapter to deal with specific vascular injuries in detail, however, general principles will be discussed with specific details given in the more common sites of injury.

General considerations

Vascular trauma can occur as a result of a variety of mechanisms including penetrating, blunt, crush, irradiation and a variety of iatrogenic injuries. The majority of penetrating injuries in civilian life in the UK are caused by knives or low-velocity handguns. Penetrating injuries in military and terrorist theatres are more often associated with high-velocity weapons, bombs and missiles, the latter can cause extensive tissue damage due to a combination of blast and shrapnel injuries.

Blunt vascular trauma is usually seen following road traffic accidents, falls, building collapses, major disasters, etc.