Martin M J, Perez-Alonso A J, Asensio J A
Trauma and Emergency Surgery Service, Legacy Emanuel Medical Center, 2801 North Gantenbein, Portland, OR, 97227, USA.
Division of Trauma Surgery and Acute Care Surgery, Department of Surgery New York Medical College, Joel A. Halpern Trauma Center, Westchester Medical Center University Hospital, Valhalla, NY, USA.
Eur J Trauma Emerg Surg. 2013 Dec;39(6):569-89. doi: 10.1007/s00068-013-0336-9. Epub 2013 Oct 23.
The evaluation and management of patients with vascular trauma or injury often involve rapid decision making in less than ideal circumstances. Immediate consequences such as hemorrhage, ischemia, compartment syndrome, thrombosis, and embolization may be life threatening and require immediate intervention. In addition, a number of regional and systemic complications of the initial vascular pathology are possible, such as shock, acute renal failure, myocardial infarction, or stroke. Understanding the disease process, as well as the optimal diagnostic and therapeutic interventions, is critically important to minimize the risk of these highly morbid or potentially mortal complications. The managing physician must be adept and well versed at both the initial management of the specific vascular injury and the many potential complications that may subsequently arise. This article will review a number of vascular-specific complications and provide details of strategies for their prevention or optimal management. These problems include traumatic injuries to the arterial or venous system, failure of vascular repairs or reconstructions, surgical site and graft infections, anastomotic complications, and compartment syndromes. In addition, arterial and venous complications secondary to the use of illicit intravenous drug use and cocaine-related vascular injury will be discussed. Finally, the increasingly important topic of iatrogenic or procedure-related vascular injuries and complications will be reviewed.
血管创伤或损伤患者的评估与管理通常需要在不太理想的情况下迅速做出决策。出血、缺血、骨筋膜室综合征、血栓形成和栓塞等直接后果可能危及生命，需要立即干预。此外，初始血管病变还可能引发一系列局部和全身并发症，如休克、急性肾衰竭、心肌梗死或中风。了解疾病过程以及最佳的诊断和治疗干预措施对于将这些高发病率或潜在致命并发症的风险降至最低至关重要。主治医生必须熟练掌握特定血管损伤的初始处理以及随后可能出现的许多潜在并发症。本文将回顾一些血管特异性并发症，并详细介绍其预防或最佳管理策略。这些问题包括动脉或静脉系统的创伤性损伤、血管修复或重建失败、手术部位和移植物感染、吻合口并发症以及骨筋膜室综合征。此外，还将讨论因使用非法静脉药物和可卡因相关血管损伤继发的动脉和静脉并发症。最后，将回顾医源性或与手术相关的血管损伤及并发症这一日益重要的话题。
