Anatomic exposures for vascular injuries

https://doi.org/10.1016/S0039-6109(01)80009-8Get rights and content

The exposure of vascular injuries is contingent on knowledge of anatomy and the limitations and boundaries for proximal and distal control of each artery. In this article, these are conveniently organized into arteries of the neck, of the chest, of the abdomen, and of the extremities. In addition, the interface between the neck and chest, and the chest and the abdomen provide particular challenges because of the need to expose two body regions frequently. The anatomy, the points of proximal and distal control, the details of exposure, and the key maneuvers required to expose particular arteries are reviewed.

References (35)

  • EH Carillo et al.

    Abdominal vascular injuries

    J Trauma

    (1997)
  • KF Ciresi et al.

    Hepatic vein and retrohepatic vena caval injury

    World J Surg

    (1990)
  • R Coimbra et al.

    Factors related to mortality in inferior vena cava injuries. A 5-year experience

    Int Surg

    (1994)
  • D Demetriades et al.

    Complex and challenging problems in penetrating neck trauma

    Surg Clin North Am

    (1996)
  • H Duncan et al.

    Cervicomediastinal arterial injuries. A surgical challenge

    Arch Surg

    (1981)
  • DV Feliciano

    Trauma to the aorta and major vessels

    Chest Surg Clin N Am

    (1997)
  • JM Graham et al.

    Management of subclavian vascular injuries

    J Trauma

    (1980)
  • Cited by (27)

    • Management of Vascular Injuries in Penetrating Trauma

      2023, Surgical Clinics of North America
    • Femoral vessel injuries: High mortality and low morbidity injuries

      2023, Current Therapy of Trauma and Surgical Critical Care
    • Lessons Learned From Treating 114 Inferior Vena Cava Injuries at a Limited Resources Environment - A Single Center Experience

      2022, Annals of Vascular Surgery
      Citation Excerpt :

      Even though smaller caval defects can be directly approached and temporarily clamped while suturing is performed, vascular control before mobilizing the liver is of paramount importance for treating larger caval perforations. This can be achieved by atrio-caval shunt insertion or total hepatic vascular exclusion (Heaney maneuver).1,6,13,51-55 There is no enough literature support to favor one or other 6,11,19,20, but hepatic vascular exclusion is simpler to perform and less risky than the atrio-caval shunt.1,19

    • Selective management of penetrating neck injuries using "no zone" approach

      2015, Injury
      Citation Excerpt :

      Having discussed the disadvantages of the zones of neck injury, the authors still believe that there are some benefits of the zones in the management of PNIs. Surgically, the zones of neck injury help surgeons prepare and select the appropriate incisions, e.g., thoracic extension of neck incision for optimal proximal vascular control in zone I injuries [21]. Moreover, difficult vascular control should be anticipated in zone III injuries, thus angiography and endovascular treatment could be useful [22]; as seen in one patient with self-inflicted gunshot wound in the present study who was managed successfully with AE to a branch of external carotid artery.

    • Complete Femoral Artery and Vein Avulsion from a Hyperextension Injury: A Case Report and Literature Review

      2009, Annals of Vascular Surgery
      Citation Excerpt :

      Proximal and distal control should be obtained prior to exposure of the injury as direct exploration of a wound that is actively bleeding or disruption of the hematoma may be disastrous. As mentioned previously, a completely transected femoral vessel may retract to a suprainguinal position, and therefore proximal control via a retroperitoneal incision at the level of the iliac vessels should be attained prior to entering the femoral triangle.22 At that point a distal longitudinal incision over the femoral artery can be made, which could be extended as needed to expose more of the vessel(s).22

    View all citing articles on Scopus
    1

    From the Division of Trauma, Burns, and Surgical Critical Care, University of California San Diego Medical Center, San Diego, California

    View full text