Transcript Vascular Trauma - St. Luke's

Vascular Trauma
Basic Science Conference
May 31, 2006
Which of the following is the most common
location for a blunt injury to the abdominal
aorta?
a) Pelvic retroperitoneum
b) By the renal vessels due to sheering injury
of the aorta
c) Origin of the celiac axis
d) Origin of the inferior mesenteric artery
C. Although rare, blunt injury to the abdominal
aorta is usually the result of impingement of
the steering wheel or a seatbelt. The origin of
the IMA is the most common location with
clinical presentation of acute aortic
thrombosis secondary to intimal disruption.
During initial assessment of a hemodynamically
stable patient with peripheral vascular
trauma which of the following characteristics
conveys the greatest urgency for repair?
a) A cool limb
b) A sensorimotor deficit
c) Time greater than 4 hours since the initial
insult
d) Diminished arterial pulse
e) Patient age greater than 60
B.) A sensorimotor deficit, although all the
characteristics are important during
evaluation of limb ischemia, a change in
neurologic function conveys the greatest
urgency because it signifies an imminent
threat of irreversible ischemic insult to the
limb.
A young male trauma patient has a penetrating deep
stab wound to the medial side of upper left arm in
close to the axilla, the patient has full radial and
brachial pulses and no neurosensory deficits. With
regards to arteriography in ruling out arterial
trauma what should be the next step in
management?
a.
Patient needs immediate surgical exploration
without angiography
b.
Arteriography should be performed due to the
location and proximity to the neurovascular bundle
c.
Arteriography is not indicated for this patient.
C. Routine arteriography in asymptomatic
patients is no longer indicated, due to
evidence demonstrating that physical exam is
very accurate in detecting arterial injuries that
would require operative repair.
With regards for
retroperitoneal
exposure match the
corresponding action
with the maneuver.
a. Mattox maneuver
b. Kocher maneuver
c.
Cattell-Braasch
maneuver
1.
2.
3.
4.
Medial reflection of the
right colon and duodenum
by incising their lateral
peritoneal attachments.
The lateral peritoneal
attachment of the sigmoid
and left colon are incised.
Used for extensive
retroperitoneal exposure
by detaching the posterior
attachments of the small
bowel mesentery toward
the duodenojejunal
ligament.
Used for SMA exposure
With regards for
retroperitoneal
exposure match the
corresponding action
with the maneuver.
a. Mattox maneuver
b. Kocher maneuver
c.
Cattell-Braasch
maneuver
1.
2.
3.
4.
Medial reflection of the
right colon and duodenum
by incising their lateral
peritoneal attachments.
The lateral peritoneal
attachment of the sigmoid
and left colon are incised.
Used for extensive
retroperitoneal exposure
by detaching the posterior
attachments of the small
bowel mesentery toward
the duodenojejunal
ligament.
Used for SMA exposure
True or False
As a general rule for a traumatic extremity
injury that involves both vascular and
orthopedic injuries, bone alignment should
take place before vascular reconstruction.
True
Orthopedic manipulation and reconstruction
may disrupt vascular repair, if the limb is
ischemic, a temporary intraluminal shunt can
be inserted to maintain perfusion while the
orthopedic procedure is being performed.
Describe the two longitudinal incisions used in
a four compartment fasciotomy of the leg and
the corresponding comparments that are
decompressed for each incision.

The anterior and lateral compartments are approached
through a lateral longitudinal incision following the anterior
margin of the fibula. The superficial and deep posterior
compartments are decompressed through a medial incision
slightly posterior to the edge of the tibia.
True or False
 Bleeding from a groin puncture wound is
often the result of inadequate groin
compression after catheter removal.
TRUE.
Important to keep in mind after femoral
catheterization.
Describe the incision made to explore a
traumatic injury to the brachial artery.
Brachial artery is exposed through a medial
arm incision in the groove between the
biceps and triceps muscles. The brachial
artery is the most frequently injured artery in
the body.
Following a motorcycle crash, a 43 yom with an
open ankle fracture and significant soft
tissue injury. He has no pulses or Doppler
signals detectable, consideration for limb
salvage would depend on all of the following
factors except:
a. Anatomic continuity of major nerves
b. Degree of bony destruction
c.
Previous diagnosis of DM II
d. Degree of soft tissue loss
e. Limb length discrepancy
C. Previous diagnosis of DM II. Factors cited by
surgeons in making the decision to
reconstruct or amputate include: nerve
integrity/plantar sensation, limb ischemia,
soft tissue coverage, and vascular supply.
Patient characteristics, including comorbidities, are rarely considered.