Vascular Injury: Endovascular and Open Surgical Management

This one-of-a-kind guide gets endovascular and trauma specialists up to date on the rapidly evolving field of vascular injury management

New technologies have created fresh opportunities to explore improved care options for patients with vascular injuries, and the discipline of vascular surgery is increasingly moving toward wider use of endovascular treatments. This makes collaboration between trauma and vascular specialists more important than ever when diagnosing and managing care of patients with vascular injuries.

Edited by highly experienced, dual-trained trauma and vascular/endovascular surgeons, Vascular Injury: Endovascular and Open Management walks readers through the process of medical, open, or endovascular management of contemporary vascular injury. Detailed description of endovascular technical elements help endovascular specialists adapt their traditional vascular surgery approaches to trauma; at the same time, the book familiarizes trauma specialists with an expanded technical skillset, as well as the strengths/limitations of technologies not provided elsewhere in traditional trauma training. Chapters include:

• A brief history of vascular injury – training, diagnosis and management
• Contemporary diagnosis of vascular injury
• General open vascular repair for trauma
• Basics of endovascular trauma management
• Endovascular tools and techniques for trauma applications
• Vascular damage control
• Cervical vascular injury
• Upper extremity injury
• Axillo-subclavian injuries
• Thoracic arch and proximal great vessels
• Abdominal aortic and Iliac artery injury
• General principles of post-operative management and surveillance
• Compartment syndrome in the setting of vascular injury
• Solid organ embolization for management of traumatic injury
• Hybrid trauma care environments and vascular trauma teams

Chapters include demographics of injury/epidemiology; anatomy; diagnosis; roles of medical management and open intervention; techniques of open exposure and management; role of endovascular intervention; techniques of endovascular exposure and management; roles for anticoagulation and antiplatelets; post-operative care and surveillance.

1.     A brief history of vascular injury – training, diagnosis and management

a.     Trauma – David Feliciano, University of Maryland

b.     Vascular / Endovascular –  Joe DuBose, University of Maryland

2.     Contemporary diagnosis of vascular injury

a.     Vascular / Trauma – David Kauvar – Brooke Army Medical Center

b.     Zach Authors – SAMMC Vascular

                                               i.     Specifics

1.     Physical exam (Hard / Soft signs, ABI)

2.     CTA (sensitivity / specificity / limitations)

3.     Traditional angiography

4.     Ultrasound (Duplex / IVUS)

5.     MRA

3.     General Open Vascular Repair for Trauma – Principles, Tools and Techniques

a.     Trauma – Elizabeth Benjamin – Emory University

b.     Vascular – Ravi Rajani – Emory University

                                               i.     Specifics of Techniques

1.     Basic principles of open vascular operations

2.     Basic tools

a.     Clamps

b.     Fogarty thrombectomy catheters (-ion)

c.     Suture -ion

d.     Pledget reinforcement

3.     Selection for and conduct of specific techniques

a.     Primary repair

b.     Patch angioplasty

c.     rSVG interposition

d.     Synthetic interposition

4.     Basics of Endovascular Trauma Management

a.     Trauma / Vascular – Megan Brenner - Riverside

b.     Endovascular – Yosuke Mastumura / Junichi – Chiba University Hospital, Japan

c.     Vascular – Derek Roberts – Ontario Canada

                                               i.     Techniques for access

1.     Anatomic landmarks at various sites

2.     Ultrasound techniques

3.     Flouroscopy guided

                                             ii.     Sheath types

                                           iii.     Wire Options

                                            iv.     Catheter Options

                                             v.     Access site closure

1.     Manual compression

2.     Percutaneous closure devices

3.     Open closure techniques

5.     Endovascular Tools and Techniques for Trauma Applications

a.     Trauma / Vascular – Jonny Morrison – University of Maryland

b.     Vascular / Vascular – Rishi Kundi – University of Maryland

                                               i.     Occlusive Balloons

1.     REBOA

                                             ii.     Embolic agents and devices

                                           iii.     Stents and stent grafts

                                            iv.     Basic inventory table

6.     Vascular Damage Control

a.     Trauma – Matt Bradley – Walter Reed Medical Center

b.     Vascular – Joe White – Walter Reed Medical Center

c.     Vascular – Todd Rasmussen – Walter Reed Medical Center

                                               i.     Specifics

1.     Principles – When? Why? – in what situations

2.     What? – Open (ligation / shunt) and Endovascular (Balloon occlusion / embolization / temporary stent graft)

a.     Shunt types

3.     How? - technique description for above

SPECIFIC VASCULAR INJURIES – Secton Editor – Joe DuBose

7.     Cervical Vascular Injury

a.     Trauma – Eugene Moore / Clay Burlew – Denver General Hospital

b.     Vascular – Melanie Hoehn – Denver General

8.     Upper extremity injury (Brachial, radial, ulnar)

a.     Trauma – Mark Bowyer, USUHS

b.     Vascular / Trauma – Sundeep Gilani, University of New Mexico

9.     Axillo-Subclavian Injuries

a.     Trauma – Tom Scalea – University of Maryland

                                               i.     Richard Betzold, MD – University of Maryland

b.     Vascular – Joe DuBose, MD – University of Maryland