Definition

Vascular trauma is any injury to an artery or vein. Arteries are blood vessels that carry oxygen-rich blood to the limbs and all organs of the body. Veins are blood vessels that carry blood back to the heart. Vascular trauma can affect not only the arteries and veins but also the lymphatic system or lymph nodes.

Vascular trauma is most common in the blood vessels of the limbs, particularly the legs, accounting for 80–90% of cases. This is typically associated with foot injuries or calcified joints. Vascular trauma typically causes bleeding and a decrease in oxygen supply to body tissues (hypoxia). Early detection and management are critical in reducing limb amputations and improving healing rates.

Vascular trauma is classified based on the type of injury it causes, such as:

• Penetrating trauma occurs when an object pierces or breaks the skin (for example, sharp or pointed objects in an armed conflict). These objects can rupture and sever blood vessels, leading to bleeding or thrombosis (blood clots)
• Blunt (non-penetrating) trauma occurs when an injury is caused by pressure on body tissue or impact from a sudden decrease in speed. This then destroys the structure of the blood vessel wall or causes the blood vessel to stretch, resulting in a tear in the blood vessel and the formation of a blood clot

Causes

Vascular trauma causes can vary depending on the mechanism of injury (blunt trauma or penetrating trauma) and location (upper or lower limb). Penetrating trauma can be caused by objects like missiles (bullets, explosion fragments, etc.) or punctures (knives, hangers, keys, etc.).

However, not all penetrating injuries are caused by physical violence. Many penetrating traumas to the limbs have been reported as a result of industrial accidents (for example, negligent use of a nail gun) or complications from medical procedures such as surgery.

Blunt trauma is typically caused by motor vehicle accidents, such as falling off a motorcycle, and can result in fractures or displacement of bone positions.

In general, some of the things that can cause the onset of vascular trauma include:

• Traffic accidents, such as bicycle and motor vehicle accidents while driving or riding
• Work-related accidents
• Accidents at home
• Stab wounds
• Sports injuries
• Domestic violence
• Injuries from fights
• Violent crime
• Complications of certain medical procedures

Risk Factor

The majority of cases of vascular trauma are the result of an accident, whether in the neighborhood, at work, or on the street. Factors that can increase the risk of an accident will undoubtedly increase the incidence of vascular trauma, such as:

• Living in a conflict area that is prone to fighting or warfare
• Working in an environment that uses many machines or tools that have the potential to injure the body
• Undergoing a medical procedure, such as surgery
• Often doing extreme sports or activities
• Disobeying traffic laws and not wearing a helmet or seatbelt while driving a motorized vehicle

Symptoms

Vascular trauma can cause a wide range of symptoms, which are often classified as serious or less serious.

Serious symptoms include:

• Absence of pulse at the end of the body from the site of vascular trauma
• Active bleeding
• Acute ischemia, a sudden drop in oxygen levels in the body's tissues
• Hematoma (localized bleeding outside a blood vessel) that is pulsating
• Presence of heart noise

Less serious symptoms of vascular trauma include:

• Decreased pulse at the end of the body from the site of vascular trauma
• Injury near an important blood vessel
• High blood pressure or shock
• Onset of nerve impairment
• Fracture or displacement of bone

Diagnosis

Vascular trauma is an emergency, so the doctor will provide initial management before proceeding with a thorough examination. If the patient's condition has stabilized, the doctor will conduct an interview with the patient (if conscious) or other witnesses to the vascular trauma.

The doctor will ask about the symptoms that arise as well as when and how the trauma occurred. Furthermore, the doctor will also perform a physical examination, such as:

• Checking the patient's general condition and degree of hemodynamic stability (blood movement)
• Checking the location of the injury on the body
• Looking for bone or joint injuries
• Looking for active bleeding
• Looking for changes in color and temperature of the limbs
• Checking for nerve impairment
• Listen to heart sounds with a stethoscope

The doctor may also perform some additional examinations to rule out hidden injuries and help determine further management, such as:

• Non-invasive vascular examinations, such as Doppler ultrasound, can rule out previously unseen arterial blood vessel damage or confirm arterial structure more clearly, particularly in patients who are difficult to examine due to swelling or open wounds
• Chest or limb X-rays will provide additional information about potential vascular trauma
• Computed Angiotomography, or MR Angiography, can aid in the initial diagnosis of vascular trauma and is especially useful for injuries to the neck, abdomen, and chest
• Arteriography is the standard test for detecting vascular trauma. It can help to determine the location and severity of the injury, as well as which blood vessels are affected

Management

The initial goal of vascular trauma treatment is to stabilize the patient's overall condition. Vascular trauma cases frequently involve injuries to multiple parts of the body, not just the blood vessels. Initial management includes opening the patient's airway, administering oxygen as needed, and inserting an IV to provide fluids and certain medications.

The management of vascular trauma may vary depending on the type and severity of the injury. Some of the options include:

• A bypass technique is used in surgery to obtain a prosthetic (artificial) or natural graft of a portion of a vein from another location in your body, typically the thigh or calf. Sometimes the injured vein is simply repaired by tying (ligation)
• Endovascular treatment is used to widen some of the injured veins using a balloon stent (a wire that can be dilated to restore blood flow)

Complications

If not treated promptly, vascular trauma can result in complications such as compartment syndrome, a set of symptoms caused by a lack of oxygen to body tissues that can lead to tissue death (necrosis).

Prevention

It is not always possible to avoid vascular trauma, but you can reduce the risk by doing the following:

• Use a seat belt when driving or riding in a motor vehicle
• Do not drive drunk or ride with a drunk driver
• Be careful when working with knives and other sharp tools
• Use caution when operating or standing near machinery
• Use caution when walking on stairs and uneven or slippery surfaces
• Avoid situations and environments that could potentially lead to physical conflict

When to See a Doctor?

If you have any injuries or wounds, particularly those from an accident, go to the emergency room (ER) right away.