Rutherford's Section 28: Vascular Trauma скачать в хорошем качестве

Rutherford's Section 28: Vascular Trauma

#VascularTrauma #TraumaSurgery #RutherfordsVascular #MedicalEducation #DamageControl #EndovascularTherapy #BCVI #BTAI #HemorrhageControl #LimbSalvage This video delves into Section 28 of Rutherford's Vascular Surgery and Endovascular Therapy, covering critical vascular trauma. It highlights the life and limb-threatening nature of these injuries in both civilian and combat settings. Historically, management shifted significantly from routine ligation to primary repair during the Korean War, using autologous vein grafts for better outcomes. Modern advancements include temporary shunts, fasciotomies to prevent compartment syndrome, negative pressure wound therapy, and endovascular techniques. However, hemorrhage remains a major killer, especially in the torso, and standard injury scores may not fully capture the severity of major vascular injuries. The discussion covers specific anatomical areas: *Neck:* Penetrating injuries are managed based on anatomical zones; hard signs require immediate surgery, while stable patients undergo CTA. Blunt cerebrovascular injury (BCVI) to the carotids or vertebrals is often asymptomatic initially, requiring screening based on mechanism and associated injuries. CTA is the primary diagnostic tool, and treatment is mainly medical (anticoagulation/antiplatelets) to prevent stroke, though endovascular options (stents) are used for unhealed severe injuries. *Chest:* Thoracic vascular trauma carries extremely high mortality if major vessels are involved. Blunt thoracic aortic injury (BTAI) is a leading cause of death after blunt trauma. Diagnosis in stable patients relies on CTA. Treatment for severe BTAI has been revolutionised by TAVAR (Thoracic Endovascular Aortic Repair), which offers significantly lower mortality and morbidity than open surgery. Anti-impulse therapy is crucial first aid. *Extremities:* Goals are hemorrhage control and blood flow restoration. Hard signs indicate urgent intervention, while soft signs warrant CTA in stable patients. Damage control principles are key for unstable patients, using tourniquets and temporary shunts. Fasciotomies are crucial, especially for lower leg injuries. Popliteal artery injuries carry the highest amputation risk, particularly with blunt trauma. Endovascular techniques have a growing role, but open repair remains common. *Repetitive/Occupational:* Chronic stress or repeated minor trauma can cause issues. Examples include Hand-Arm Vibration Syndrome (HAVS) from vibrating tools and Hypothenar Hammer Syndrome (HHS) from forceful palm impact damaging the ulnar artery. Athletes can develop vascular problems from repetitive motions, such as thoracic outlet syndrome or compression injuries. Management often involves stopping the injurious activity, medical therapy, or sometimes surgery. The field is constantly evolving, requiring ongoing learning, multidisciplinary collaboration, and vigilance in diagnosis and treatment.