All You Need To Know About Peripheral Vascular Injuries!

An injury to an artery or to a vein is defined as a Vascular Injury. A Vascular Injury of any kind poses a great challenge in daily lifestyle. These injuries require urgent medical attention and intervention if preserving a limb is desirable. Sometimes, serious Vascular Injuries do not show significant symptoms leading to a delayed diagnosis. Such injuries are mostly seen in the youth, especially the male population. However, Peripheral Vascular Injuries might also be caused by firearms, road accidents, diagnostic procedures, and bomb blasts, or due to other certain sudden and unfortunate incidents.

Types of Vascular Injuries-
Vascular Injuries can be divided into the following six major groups primarily:

● Spasm: A spasm is caused due to reduced blood flow in the vessels caused by localized trauma.

● Thrombosis: It refers to a blood clot which partially or completely blocks the blood vessel and might be caused due to an injury to the vascular tissues.

● Arterial Emboli: Arterial Emboli refers to a sudden interruption of blood flow to a body part or an organ resulting from blockage due to a blood clot that acts as an embolus (an unattached mass traveling through the bloodstream and capable of clogging arteries, veins, and capillaries).

● Laceration: Also known as Transection, it causes irregular vascular tears and segmental loss due to blunt trauma or high-velocity missiles. A longitudinal and badly lacerated vessel might lead to a greater blood loss than a neatly transected vessel.

● Contusion: Also referred to as Intimal Flap, it is the tearing of the inner coat (intima) of the blood vessel caused due to extra stretch or a damaging and concussive force. A small flap measuring less than five millimeters may not necessarily block blood flow but can aggravate thrombosis. However, a larger flap might protrude into the inner wall of the blood vessel causing restricted blood supply.

● Arterio-Venous Fistula: When an artery and its adjacent vein are simultaneously injured, it leads to their connection causing the blood to flow from artery to the vein (high pressure to low pressure). It leads to inadequate blood supply in the desired direction. Arterio-Venous Fistula can possibly cause congestive cardiac failure.

● Aneurysm and Pseudoaneurysm: Aneurysm refers to the bulging of the blood vessel, and is rarely produced. It is generally seen that Pseudoaneurysm follows trauma instead of Aneurysm. Pseudoaneurysm refers to collective thrombosis.

Diagnosis-
There are several non-invasive and invasive methods for the treatment of Peripheral Vascular Injuries. The non-invasive tests include Ankle-brachial Index, Hand Held Doppler, Duplex Ultrasound, B-mode Ultrasound, and Color Flow Doppler Ultrasound.
The invasive tests include Angiography, Magnetic Resonance Angiography, and Digital Subtraction Angiography.

Treatment-
There are several treatment options that are available for correcting Peripheral Vascular Injuries.

● Primary Anastomosis: Referring to a surgical connection between adjacent blood vessels, it is performed when there is minimal or no segmental loss. Primary Anastomosis in Segmental loss has a high risk of thrombosis.

● Reverse Saphenous Vein Graft: When the segmental loss is greater than two centimeters, Saphenous vein (the largest vein in the body running along the length of the lower limb) is harvested. The vein is used upside down in the repair of the artery. It is ensured that there is no tension on the suture line or any kink in
graft.

● Lateral Repair: When there is a lateral tear, it is primarily sutured at the tear site.

Take Away-
There are several treatment options available for peripheral vascular injuries. However, it is always advisable to consult a doctor before opting for any treatment as the condition of a patient varies from patient to patient.