Indications and Techniques for Vascular Exploration

Vascular injury management is a fundamental skill for trauma surgeons. Patient assessment begins with identification of all life-threatening injuries followed by the identification of hard and soft signs of vascular injury. Life-threatening bleeding may come from a vascular injury or from elsewhere. Hard signs in general mandate exploration, whereas soft signs permit more further workup. The operative principle of proximal and distal control is critical and has traditionally been achieved via classical open operative exposures. Recently, endovascular options for vascular control and definitive management of vascular injuries have emerged. In regions of difficult anatomy, endovascular and open techniques can be combined in a hybrid approach to minimize morbidity. A number of damage control options exist in the setting of complex injury or physiologically compromised patients, which include temporary shunting or ligation.