Introduction:
Vascular injury is a common cause of death in trauma. Despite the increasing role of interventional radiology, major trauma often still mandates vascular surgical involvement. Given the changing paradigms in management, this presentation reviews the approach to vascular trauma in severely injured patients at the Princess Alexandra Hospital, a tertiary trauma centre in Brisbane.
Methods:
Cases of vascular injury in patients with an injury severity score (ISS) >12 were identified between 1/5/22–31/7/24 through cross-referencing a retrospective trauma database and the Australasian Vascular Audit. Injuries, interventions, and outcomes were collected.
Results:
67 cases were identified (2.5/month), 29 requiring intervention (58.6% open/mixed, 41.4% endovascular). 53 (79.1%) were secondary to blunt trauma. Penetrating trauma was less common (14, 20.9%), associated with lower ISS (21.2 vs 31.0), however was more likely to require vascular intervention (85.7% vs 32.1%), with a higher mortality when required (21.4% vs 0%). Aortic injury was most common (46.3%), followed by peripheral (28.4%) and cerebrovascular (25.4%). 29.0% of aortic injuries underwent intervention, eight endovascular (0% mortality), and one open (100% mortality). 89.7% of interventions were emergent within 24 hours, and 55.2% ASA 4 or above. As a result, the primary surgeon was a registrar in only 31.0% of cases, and 23.5% when open surgery was required.
Conclusion:
Major trauma requiring urgent vascular intervention remains common. Despite increasing endovascular experience, open surgery is still required, particularly following penetrating trauma and often in dire circumstances. Ensuring trainees gain experience in trauma and open surgery is important for future trauma care.