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Rich’s Vascular Trauma E-Book

Rich’s Vascular Trauma E-Book

Todd E Rasmussen | Nigel R M Tai


Additional Information

Book Details


Published in association with the Society for Vascular Surgery (SVS), the newly updated edition of Rich’s Vascular Trauma draws on civilian and military authorities from around the world to offer comprehensive and up-to-date coverage of the management of vascular injury. Anatomic patterns of vascular trauma including extremity, torso and cervical injury are reviewed in detail, including the latest techniques to manage non-compressible torso hemorrhage. You’ll have access to all of the current innovations across the broad spectrum of vascular trauma, presented in a well-organized fashion that allows you to quickly hone-in on the most important issues in patient care and management.

  • Emphasizes the current management of civilian vascular injuries with an historical reflection of pioneering contributions from the battlefield.
  • Combines the largest existing database of military vascular trauma with the experience of one of the nation's premier civilian trauma centers.
  • Examines operative techniques and "damage control" for vascular traumas.
  • For the first time, includes a novel International Perspectives section featuring fascinating accounts of vascular trauma from nine leading surgeons from five continents. This section focuses on innovative surgical treatments tailored to locally developed pathways of care, training solutions, and regional injury patterns.
  • End-to-end coverage of all phases of acute vascular injury care, including a new assessment of the implications of vascular trauma in the pre-hospital setting (i.e. point of injury and en-route care).
  • Covers the emerging hot topics, including endovascular procedures to manage trauma, contemporary use of vascular shunts, and a modern reappraisal of resuscitative endovascular balloon occlusion of the aorta for shock.
  • An innovative chapter on the systems approach and quality improvement in vascular trauma, offering information and tactics for all providers wishing to understand how clinical systems underpin patient outcome and recovery from this challenging injury pattern.
  • A combined civilian and military authorship from internationally recognized authorities draws on the best available evidence, experience, and lessons-learned from Afghanistan, Iraq, and the "urban battlefield."
  • Medicine eBook is accessible on a variety of devices.

Table of Contents

Section Title Page Action Price
Front cover cover
Inside front cover ifc1
Rich's Vascular Trauma i
Copyright page iv
Dedication v
Contributors vii
Foreword xiii
References xiii
Preface xv
References xv
Table of Contents xvii
1 Background 1
1 The Vascular Injury Legacy 3
Abstract 3.e1
Key Words: 3.e1
Initial Control of Hemorrhage 3
Early Vascular Surgery 5
World War I Experience 8
World War II Experience 8
Experiences During the Korean Conflict 9
Experience in Vietnam 10
Vietnam via Gulf War 1991 to Afghanistan and IRAQ 11
Civilian Experience 11
Conclusion 11
References 12
2 Epidemiology of Vascular Injury 13
Abstract 13.e1
Key Words: 13.e1
Introduction 13
Context and Categorization of Vascular Trauma 13
Vascular Trauma and Military Conflict 14
Vascular Trauma in Combat Troops 14
Vascular Trauma Among Local National Populations 15
Vascular Trauma and Civilian Populations 16
Urban Populations 16
Rural Populations 17
Vascular Trauma and Patient Age 17
Iatrogenic Vascular Trauma 18
Vascular Trauma, Lifestyle, and Socioeconomic Factors 18
Summary 19
References 19
3 Systems of Care in the Management of Vascular Injury 21
Abstract 21.e1
Key Words: 21.e1
Introduction 21
Trauma Systems Overview 21
Key Components of a Trauma System 21
Trauma Center Function 23
Trauma Systems in Combat Casualty Care 24
Organization of the Joint Theater Trauma System 24
Challenges of Systemizing Vascular-Injury Care 25
Ownership and Responsibilities 25
Data Collection and Comparison 26
Uptake of Clinical Practice Guidelines 26
Introduction and Tracking of New Technology 26
Conclusion 27
References 27
4 Pathophysiology of Vascular Trauma 28
Abstract 28.e1
Key Words: 28.e1
Introduction 28
Pathogenesis of Ischemia and Reperfusion 28
Clinical Practice on the Battlefield 28
The Ischemic Threshold 29
Damage Control Resuscitation 29
Conclusion 31
References 31
2 Diagnosis and Early Management 33
5 Diagnosis of Vascular Injury 35
Abstract 35.e1
Key Words: 35.e1
Introduction 35
The Mechanism, Setting, and Patterns of Injury 35
Injury Pattern Recognition 35
Head and Neck Vascular Injuries 35
Thoracic Vascular Injuries 36
Abdominal Vascular Injuries 36
Upper Extremity Vascular Injuries 37
Lower Extremity Vascular Injuries 38
Other High-Risk Injury Patterns 39
Physical Examination 39
Doppler Ultrasound Adjunctive Measures 40
Clearing the Trauma Patient for the Presence of Vascular Injury 40
Definitive Diagnosis of Vascular Injury 41
Surgical Exploration for Vascular Injury 41
Portable Angiography in the Trauma Bay or the Operating Room 41
Multidetector CT Angiography 41
Catheter Angiography in Fixed-Imaging Suite 42
Compartment Syndrome 42
Summary 42
References 43
6 Imaging for the Evaluation and Treatment of Vascular Trauma 44
Abstract 44.e1
Key Words: 44.e1
Historical Background 44
Imaging Modalities 44
Angiography 44
Indications 44
Preparation 45
Pitfalls and Danger Points 46
Operative Strategy 46
Operative Technique 47
Postoperative Care 48
Complications 48
Ultrasound 48
Indications 49
Preparation 50
Pitfalls and Danger Points 50
Strategy 50
Technique 51
Postexamination Care 52
Complications 52
Computed Tomography 52
Indications 52
Preparation 52
Pitfalls and Danger Points 52
Strategy 54
Technique 54
Postexamination Care 55
Complications 55
References 55
7 Damage Control and Immediate Resuscitation for Vascular Trauma 56
Abstract 56.e1
Key Words: 56.e1
Introduction 56
Definitions 56
Resuscitation Paradigms 57
Horizontal Versus Vertical Resuscitation 57
Three-Dimensional Versus Two-Dimensional Resuscitation 57
Preparation 58
Techniques and Procedures 59
Fluids and Medications 60
Imaging 60
Resuscitation End Points 61
Resuscitation Ethics 62
References 62
8 Vascular Disruption and Noncompressible Torso Hemorrhage 64
Abstract 64.e1
Key Words: 64.e1
Introduction 64
The Military and Civilian Epidemiology of Torso Hemorrhage 64
Defining Noncompressible Torso Hemorrhage 65
Epidemiology of Noncompressible Torso Hemorrhage 66
Clinical Management Strategies in Torso Hemorrhage Control 66
Damage Control Surgery and Damage Control Resuscitation 66
Resuscitative Surgical Maneuvers 66
Operative Exposures and Control of Nontraditional Vascular Trauma and Hemorrhage 67
Thoracic Exposure and Control of Pulmonary Parenchymal Hemorrhage 67
Abdominal Exposure and the Control of Splenic, Hepatic, and Renal Hemorrhage 68
Pelvic Access and Control of Pelvic Hemorrhage 68
Summary 69
References 69
3 Definitive Management 71
9 Cardiac, Great Vessel, and Pulmonary Injuries 73
Abstract 73.e1
Key Words: 73.e1
Introduction 73
Evaluation and Management in the Emergency Center 73
Mechanism of Injury 73
Advanced Trauma Life Support: Primary Survey and Initial Resuscitation 73
The Injured Heart 75
History 75
Incidence 75
Penetrating Trauma 75
4 Hot Topics in Vascular Injury and Management 183
16 Damage Control: 185
Abstract 185.e1
Key Words: 185.e1
Introduction 185
Preventable Death 185
General Aspects of Care 185
Control of Extremity Hemorrhage: Tourniquets 185
Control of External Nonextremity Hemorrhage 187
Hemostatic Agents 187
Junctional Bleeding 189
Hemorrhage Control: Direct Pressure 190
Noncompressible Hemorrhage 190
Prevention and Treatment of the Coagulopathy of Trauma 191
Intravenous Hemostatic Agents 191
Prehospital Fluid Resuscitation: Crystalloids and Colloids 192
Prehospital Fluid Resuscitation: Plasma 192
Care During Transport 193
Damage Control Resuscitation 193
Comprehensive Tactical Evacuation Care Considerations 194
Future Directions 195
References 195
Bibliography 197
17 Surgical Damage Control and Temporary Vascular Shunts 198
Abstract 198.e1
Key Words: 198.e1
Introduction 198
Historical Use of Intravascular Shunts 198
Modern Use of Intravascular Shunts 198
Indications 199
Shunt Materials 199
Insertion Technique 200
Dwell Time 201
Special Considerations 202
Anatomic Location (Proximal Large Vessels Versus Distal Small Vessel) 202
Anticoagulation 203
Venous Shunting 203
Role in Limb Salvage 204
Fasciotomy (Prophylactic) 204
Vascular Branch Points 204
Truncal Vascular Injuries 204
Conclusion 205
References 205
18 Damage Control: 206
Abstract 206.e1
Key Words: 206.e1
Introduction 206
Definition of Problem Identification of the Optimal Vascular Conduit 206
Types of Conduit 206
Autologous Conduit 207
Prosthetic Conduits 207
Biologic Conduits: Allografts 208
Biologic Conduits: Xenografts 208
Decision Making in the Choice of Conduit 208
Location and Nature of the Injury 208
Thoracic and Abdominal Injuries 208
Extremity Vessels 209
Ideal Conduit for Vascular Trauma 209
Available Conduit in Austere and Military Settings 210
Autologous Conduits 210
Prosthetic Conduits 211
Future Considerations 212
Artificial Blood Vessels 212
Improvements in Storage 212
Conclusion 212
References 213
19 Endovascular Management of Acute Vascular Injury 215
Abstract 215.e1
Key Words: 215.e1
Introduction 215
Endovascular Management of Carotid Arterial Injury 215
Endovascular Management of Vertebral Artery Injury 217
Endovascular Management of Blunt Thoracic Aortic Injury 217
Repair Versus Observation 218
Endovascular Management of Blunt Abdominal Aortic Injury 219
Endovascular Management of Axillosubclavian Artery Injury 221
Endovascular Management of Extremity Vascular Injury 222
Aortic Occlusion Balloons for Penetrating Trauma and Blunt Trauma 223
Long-Term Follow-Up 223
References 223
20 Pediatric Vascular Injury 226
Abstract 226.e1
Key Words: 226.e1
Introduction 226
Demographics and Etiology 226
Anatomic and Physiologic Considerations 228
Diagnostic Evaluation 228
Management of Pediatric Vascular Injuries 229
Extremity Injuries 229
Supracondylar Humerus Fractures and Brachial Artery Injuries 231
Fasciotomy 232
Truncal Vascular Injuries 232
Endovascular Applications 232
Nonoperative Management 232
ECLS Cannulation 233
Adjuncts to the Management of Vascular Injuries in Children 233
Temporary Vascular Shunts 233
Role of Heparin 233
Lytic Therapy 233
Postoperative Management 233
Outcomes Following Pediatric Vascular Injuries 234
Future Directions 234
Conclusions 234
References 234
21 Inferior Vena Cava Filters 236
Abstract 236.e1
Key Words: 236.e1
Filters and Terminology 236
Indications 236
Recommended Indications 236
Expanded Indications 236
Trauma 236
Contraindications 238
Techniques 238
Insertion 238
Retrieval 238
Complications 239
Short-Term Complications 239
Long-Term Complications 239
Summary 240
References 241
22 Soft-Tissue and Skeletal Wound Management in the Setting of Vascular Injury 242
Abstract 242.e1
Key Words: 242.e1
Introduction 242
Epidemiological Factors 242
Grading of Orthopedic Fractures 242
Salvage Versus Amputation 243
Strategies in Managing the Severely Injured Limb 243
Sequencing of Interventions 243
Major Limb Amputation for Trauma 244
Assessment of the Injured Extremity 244
Initial Surgical Management 246
Reconstruction 248
Fix and Flap 248
Choice and Type of Reconstruction 249
Flap Reconstruction 249
Free Flaps 249
Muscle Versus Fasciocutaneous Flaps 249
Commonly Used Flaps for Lower Limb Wounds 249
Commonly Used Flaps for Upper Limb Wounds 250
Outcomes of Limb Salvage 250
Summary 251
References 251
Bibliography 251
23 Vascular Surgery in the Austere Environment 252
Abstract 252.e1
Key Words: 252.e1
Introduction 252
Fundamentals 252
Neck Injuries 253
Carotid Injuries 253
Associated Neck Injuries 254
Operative Management of Zone III Injuries 255
Operative Management of Zone I Injuries 255
Upper Limb Vascular Injuries 256
Brachial and Forearm Vessels 256
Abdominal Vascular Injuries 259
Lower Limb Vascular Injuries 261
Futility of Treatment 263
Soft-Tissue Injury 263
Vascularized Composite Muscle Flaps for Coverage of Vascular Reconstruction 264
Brachioradialis Flap 264
Rectus Abdominus Flap 264
Soleus and Gastrocnemius Muscle Flaps 264
Fasciocutaneous Flaps 264
Radial Forearm Flap 264
Forearm Amputation 264
Working in Austere Environments 265
References 268
24 Vascular Trauma: 269
Abstract 269.e1
Key Words: 269.e1
Introduction 269
Vascular Training in Evolution 270
Vascular Trauma Training Considerations 270
Vascular Trauma Training Tools 272
Team-Based Training for Vascular Trauma 272
Simulation-Based Training for Vascular Trauma 273
Current Vascular Surgery Training Curricula 275
The Definitive Surgical Trauma Care Course 275
Definitive Surgical Trauma Skills (DSTS) 275
Advanced Trauma Operative Management 275
Advanced Surgical Skills for Exposures in Trauma (ASSET) 276
The Military Operational Surgical Training Course 277
European Vascular Masterclass (the Pontresina Course) 277
Summary 278
References 278
5 International Perspectives 281
25 Australia and New Zealand 283
Abstract 283.e1
Key Words: 283.e1
Region-Specific Epidemiology 283
Region-Specific Systems of Care 283
Surgical Training and Certification 283
Access to Care 284
Prehospital Care 284
Region-Specific Considerations for Diagnosis 284
Region-Specific Treatment Strategies 285
Strategies to Sustain and Train the Next Generation of Trauma Surgeons 285
References 286
26 Asia: 287
Abstract 287.e1
Key Words: 287.e1
Introduction 287
Epidemiology 287
Systems of Care and Transport 287
First Line of Care 287
Second Line of Care 287
Third Line of Care 288
Considerations for Diagnosis 290
Treatment Strategies 290
Sustain and Train the Next Generation 292
References 292
27 Europe: 293
Abstract 293.e1
Key Words: 293.e1
Region-Specific Epidemiology 293
War Vascular Injuries 293
Region-Specific System of Care 293
Region-Specific Considerations for Diagnosis 295
Region-Specific Treatment Strategies 295
Strategies to Sustain and Train the Next Generation of Trauma Surgeons 296
References 296
28 Scandinavia and Northern Europe 297
Abstract 297.e1
Key Words: 297.e1
Introduction 297
Region-Specific Epidemiology 297
Region-Specific Systems of Care 297
Region-Specific Considerations for Diagnosis 299
Region-Specific Treatment Strategies 299
Strategies to Sustain and Train the Next Generation of Trauma Surgeons 299
References 300
29 Europe: 301
Abstract 301.e1
Key Words: 301.e1
Introduction 301
Afghanistan 301
Region-Specific Epidemiology 301
Region-Specific Systems of Care 302
Region-Specific Considerations for Diagnosis 303
Region-Specific Treatment Strategies 304
Strategies to Sustain and Train the Next Generation of Trauma Surgeons 305
The North Caucasus 305
Region-Specific Epidemiology 305
Region-Specific Systems of Care 305
Region-Specific Considerations for Diagnosis 306
Region-Specific Treatment Strategies 306
Strategies to Sustain and Train the Next Generation of Trauma Surgeons 307
Conclusion 307
References 308
30 Europe: 309
Abstract 309.e1
Key Words: 309.e1
Region-Specific Epidemiology 309
Region-Specific Systems of Care 309
Region-Specific Considerations for Diagnosis 310
Region-Specific Treatment Strategies 311
Endovascular Repair of Vascular Trauma 314
References 314
31 Vascular Trauma in Israel 316
Abstract 316.e1
Key Words: 316.e1
Epidemiologic Considerations 316
Incidence of Vascular Trauma 316
Evacuation Methods of Vascular Injuries 317
Israeli Vascular System of Care 317
Considerations for Diagnosis 318
Treatment Strategies 319
Hemorrhage Control 319
Triage in the Emergency Room 320
Priority in the Operating Room 320
Methods of Vascular Repair Employed 320
Endovascular Methods 320
Compartment Syndrome and Fasciotomy 321
Venous Injury 322
External Temporary Shunt 322
Amputation 322
Late Complications 322
Mortality from Vascular Injuries 323
Prospects for the Future 323
Conclusions 323
References 323
32 South Africa 324
Abstract 324.e1
Key Words: 324.e1
Region-Specific Epidemiology 324
Region-Specific Systems of Care 325
Techniques of Care 325
Management of Acute Vascular Hemorrhage 325
Management of Acute Ischemia 326
Region-Specific Considerations for Diagnosis 326
Region-Specific Treatment Strategies 326
Neck 326
Cervicomediastinal Injuries 326
Transmediastinal or Transabdominal Torso Injuries 326
Cardiac Injuries 327
Strategies to Sustain and to Train the Next Generation of Trauma Surgeons 327
References 328
33 Vascular Trauma in Latin America 329
Abstract 329.e1
Key Words: 329.e1
Epidemiology 329
Specific Systems of Care in the Region 329
Regional Considerations for the Diagnosis and Management of Vascular Trauma 329
Strategies to Train the Next Generation of Trauma Surgeons 332
References 332
34 Implications of Vascular Trauma in Brazil 333
Abstract 333.e1
Key Words: 333.e1
Introduction 333
Epidemiology 333
Trauma in Brazil 333
Urban Conflicts 333
The Rural Setting 333
Automobile Crashes 334
Evaluation and Diagnosis of Vascular Injury in Brazil 334
Region-Specific Treatment Strategies (Acute Vascular Hemorrhage and Acute Ischemia) 335
Specific Vascular-Injury Patterns 335
Carotid Injuries 335
Subclavian Injuries 335
Thoracic Vascular Trauma 336
Abdominal Vascular Trauma 336
Extremity Vascular Trauma 336
Regional Strategies to Sustain and Train the Next Generation of Trauma Surgeons 336
References 337
Index 339
A 339
B 340
C 340
D 341
E 342
F 342
G 343
H 343
I 343
J 344
K 344
L 344
M 345
N 345
O 345
P 346
Q 346
R 346
S 347
T 348
U 348
V 349
W 350
X 350
Z 350
Inside back cover ibc1