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Surgery.(General 2).Vascular > Arterial.3. Arterial injuries > Flashcards

Arterial.3. Arterial injuries Flashcards

1
Q

CAUSES of arterial injuries

A
  • Open

* Closed

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2
Q

Open CAUSES of arterial injuries

A
  1. Penetrating injury e.g. stabs, bullets

2. Following arterial cannulation.

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3
Q

Closed CAUSES of arterial injuries

A
  1. Plaster or tourniquet compression.
  2. Fracture or dislocation such as :
    * Supracondylar fracture of humerus & brachial artery-
    * Supracondylar fracture of femur & popliteal artery
  3. Blunt injuries.
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4
Q

TYPES of arterial injuries

A

A. Arterial injury without division :

B. Arterial injury with division :

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5
Q

Pathogenesis of Arterial injury without division in TYPES of arterial injuries

A
  1. Arterial spasm

2. Arterial contusion

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6
Q

Etiology of Arterial spasm in Pathogenesis of Arterial injury without division

A

Occurs as a result :

  • Irritation e.g. blunt trauma,
  • Tourniquets.
  • Passage of high velocity missile near vessel (“ near miss”).
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7
Q

Pathogenesis of Arterial injury with division in TYPES of arterial injuries

A
  1. Complete division

2. Partial division

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8
Q

pathogenesis of Complete division in Pathogenesis of Arterial injury with division in TYPES of arterial injuries

A

Both ends bleed profusely but soon bleeding decreases because the intima curls inside the lumen while the media contracts & the divided stumps retracts

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9
Q

the reason why bleeding decreases soon in pathogenesis of Complete division in Pathogenesis of Arterial injury with division

A

because the intima curls inside the lumen while the media contracts & the divided stumps retracts

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10
Q

pathogenesis of Partial division in Pathogenesis of Arterial injury with division in TYPES of arterial injuries

A
  • The contraction & retraction of the vessel wall cause the tear in the vessel wall to gap.
  • The artery will continue to bleed profusely either externally or internally producing a pulsating haematoma
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11
Q

the reason why profuse bleeding occurs in pathogenesis of Partial division in Pathogenesis of Arterial injury with division in TYPES of arterial injuries

A
  • as The contraction & retraction of the vessel wall cause the tear in the vessel wall to gap.
  • The artery will continue to bleed profusely either externally or internally producing a pulsating haematoma
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12
Q

COMPLICATIONS of arterial injuries

A
  1. Haemorrhage.: Primary, secondary, or reactionary.
  2. Ischemia
  3. Aneurysm formation : Arterial or arterio-venous.
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13
Q

CLINICAL PICTURE of arterial injuries

A
  • General examination

* Local examination

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14
Q

General examination in CLINICAL PICTURE of arterial injuries

A
  • Vital signs for evaluation of the magnitude of blood loss.

* To look for other injuries.

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15
Q

Local examination in CLINICAL PICTURE of arterial injuries

A

A. Hard signs

B. Soft signs

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16
Q

Hard signs in Local examination in CLINICAL PICTURE of arterial injuries

A
  • Significance

* List

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17
Q

Significance of Hard signs in Local examination in CLINICAL PICTURE of arterial injuries

A

These are sure signs of arterial injury

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18
Q

List of Hard signs in Local examination in CLINICAL PICTURE of arterial injuries

A
  1. External arterial bleeding.
  2. Loss of distal pulses.

3- Any of the classic manifestations of acute ischemia (6P).

  1. Pulsating or expanding haematoma.
19
Q

Soft signs in Local examination in CLINICAL PICTURE of arterial injuries

A
  • Significance

* List

20
Q

Significance of Soft signs in Local examination in CLINICAL PICTURE of arterial injuries

A

These are less specific (equivocal) signs.

21
Q

List of Soft signs in Local examination in CLINICAL PICTURE of arterial injuries

A
  1. Small or moderate sized haematoma that is not pulsating and not expanding.
  2. Proximity of penetrating wound to a major vascular structure.
  3. Adjacent nerve injury: producing neurological deficit.
22
Q

INVESTIGATIONS of a case with arterial injury

A

a. In patients with hard signs
Immediate surgical exploration is indicated without any diagnostic studies as any delay in treatment is dangerous

b.In patients with soft signs: urgent investigations are needed.

23
Q

urgent investigations In patients with soft signs in INVESTIGATIONS of a case with arterial injury

A
  1. Plain X-ray :
  2. Arteriography : most accurate
  3. Duplex scan
24
Q

The reason why plain X-ray is done in urgent investigations In patients with soft signs in INVESTIGATIONS of a case with arterial injury

A

to detect foreign bodies or fractures.

25
Q

investigations of a case with hard signs of arterial injury

A

Immediate surgical exploration is indicated without any diagnostic studies as any delay in treatment is dangerous

26
Q

TREATMENT of arterial injury

A

I. Immediate Management

II. Definitive Management

III. Distal Fasciotomy

  • If there is a bony fracture, it must be fixed first
27
Q

Immediate Management in TREATMENT of arterial injury

A
  1. Resuscitation by blood and IV fluids.
  2. Heparinization
  3. Prophylactic antibiotics should be given early
28
Q

indication of Heparinization in Immediate Management in TREATMENT of arterial injury

A

only in patients with isolated vascular injury presenting with ischemia

29
Q

the reason why Prophylactic antibiotics should be given early in the Immediate Management of a case with arterial injury

A

as infection may cause secondary hemorrhage

30
Q

Definitive Management in TREATMENT of arterial injury

A

Immediate Exploration & Repair of :

A. Complete Arterial Division :

B. Partial Arterial Division :

C. Contusion

D. Spasm

31
Q

Immediate Exploration & Repair of Complete Arterial Division in Definitive Management in TREATMENT of arterial injury

A
  1. Direct end to end anastomosis. If there is no gap.
  2. Arterial graft:
  3. Ligation of both ends.Only for small unnamed arteries.
32
Q

The reason why repair of Complete Arterial Division is done in oblique line sutures in Immediate Exploration & Repair of Complete Arterial Division in Definitive Management in TREATMENT of arterial injury

A

to avoid annular stricture

33
Q

Arterial graft in Immediate Exploration & Repair of Complete Arterial Division in Definitive Management in TREATMENT of arterial injury

A
  • Indication

* Types of graft

34
Q

Indication of Arterial graft in Immediate Exploration & Repair of Complete Arterial Division in Definitive Management in TREATMENT of arterial injury

A

if there is gap

35
Q

Types of graft in Arterial graft in Immediate Exploration & Repair of Complete Arterial Division in Definitive Management in TREATMENT of arterial injury

A
  1. Autogenous reversed saphenous vein graft. for small arteries
  2. Synthetic grafts of Dacron or Teflon for Medium sized & large arteries
36
Q

Immediate Exploration & Repair of Partial Arterial Division in Definitive Management in TREATMENT of arterial injury

A

in case of :

  1. Longitudinal tear of Large artery
  2. Longitudinal tear of Medium sized artery
  3. Transverse tear and involves < 1/2 circumference
  4. Transverse tear and involves > 1/2 circumference
37
Q

Immediate Exploration & Repair of Partial Arterial Division, in Definitive Management in TREATMENT of arterial injury, in case of Longitudinal tear of Large artery

A

do Direct suture.

38
Q

Immediate Exploration & Repair of Partial Arterial Division, in Definitive Management in TREATMENT of arterial injury, in case of Longitudinal tear of Medium sized artery

A

do Vein patch graft

39
Q

Immediate Exploration & Repair of Partial Arterial Division, in Definitive Management in TREATMENT of arterial injury, in case of Transverse tear and involves < 1/2 circumference

A

Direct anastomosis.

40
Q

Immediate Exploration & Repair of Partial Arterial Division, in Definitive Management in TREATMENT of arterial injury, in case of Transverse tear and involves > 1/2 circumference

A

Turn it into complete

41
Q

Immediate Exploration & Repair of Contusion in Definitive Management in TREATMENT of arterial injury

A

Excision of the contused part and grafting.

42
Q

Immediate Exploration & Repair of Spasm in Definitive Management in TREATMENT of arterial injury

A

1- Local application of papaverine or novocaine.

  1. Proximal intra-arterial injection of heparinized isotonic saline.
  2. If the spasm still persists, excision of the spastic segment with a saphenous vein graft is performed.
43
Q

Indications of Distal Fasciotomy in Definitive Management in TREATMENT of arterial injury

A

It is a must in the following situations

  1. In late cases (> 6 hours).
  2. In presence of muscle edema

Surgery.(General 2).Vascular (16 decks)

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