Rutherfor's 183: Vascular Trauma: Extremity скачать в хорошем качестве

Rutherfor's 183: Vascular Trauma: Extremity

#VascularTrauma #ExtremityTrauma #TraumaSurgery #VascularSurgery #RutherfordsVascular #MedicalEducation #EmergencyMedicine #LimbSalvage #DamageControl #Endovascular #CompartmentSyndrome #PoplitealArtery #HemorrhageControl #AmputationRisk This video provides a detailed look into extremity vascular trauma, drawing from Rutherford's Vascular Surgery and Endovascular Therapy. While a percentage of overall trauma, these injuries cause a disproportionate amount of morbidity and mortality. Arterial injuries occur about equally in upper and lower limbs, but mechanisms and locations differ; blunt trauma is more common in legs (often injuring the popliteal artery), while penetrating trauma affects arms and legs equally (often targeting the SFA in the leg). Blunt trauma is associated with more severe and multiple injuries. Associated injuries are frequent, including fractures (80-100% with blunt arterial injury), nerve damage (higher in upper extremity), and significant soft tissue damage. Venous injuries accompany arterial injuries 15-35% of the time but aren't consistently linked to limb loss, though major leg vein ligation can cause temporary swelling and VTE risk is high regardless of repair. Diagnosis is guided by patient stability and presentation, shifting from the older hard/soft sign system to focusing on hemorrhagic or ischemic signs. CTA is the preferred diagnostic tool, offering speed and detail on associated injuries. Management prioritises immediate hemorrhage control, often using tourniquets or manual pressure. Temporary arterial shunts are vital damage control tools to maintain flow during resuscitation or complex repairs, especially in the leg. Fasciotomy is crucial, particularly for lower leg arterial repairs, to prevent or treat compartment syndrome. Definitive repair options include open surgery (patch, anastomosis, or preferably vein grafts) and increasingly endovascular techniques (stents, embolization), chosen based on injury type and location. Blunt popliteal artery injuries and those involving multiple tibial arteries carry the highest amputation risk. The decision between limb salvage and primary amputation in severe cases is complex, often guided by multidisciplinary assessment rather than solely the vascular injury. While survival is improving, long-term functional outcomes and quality of life remain areas needing further research.