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VOLUME 13 , ISSUE 2 ( May-August, 2024 ) > List of Articles

REVIEW ARTICLE

Vascular Damage Control Surgery in Limited Resource Environments: A Narrative Review

Adenauer M de Oliveira Góes Junior, Viktor Reva, Simone Fajer, Marcelo AF Ribeiro Jr

Keywords : Damage control, Resuscitative endovascular balloon occlusion of the aorta, Trauma, Vascular injuries, Vascular shunt

Citation Information : Góes Junior AM, Reva V, Fajer S, Ribeiro Jr MA. Vascular Damage Control Surgery in Limited Resource Environments: A Narrative Review. Panam J Trauma Crit Care Emerg Surg 2024; 13 (2):88-95.

DOI: 10.5005/jp-journals-10030-1458

License: CC BY-NC 4.0

Published Online: 20-08-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aim and background: Vascular injuries are among the leading causes of exsanguination in trauma patients. However, complex surgical procedures are not appropriate for patients in critical physiological conditions. This paper aims to present practical suggestions for these situations through a review of how to improvise temporary vascular shunts (TVSs), suggestions on which vessels can be ligated, when to perform fasciotomies, and when to indicate primary amputation. Methods: A narrative review of the literature was performed, and authors’ case images were employed to illustrate practical aspects regarding vascular damage control in limited resource environments. Results: Paramount tools for temporary hemostasis include the use of tourniquets for compressible vascular injuries, balloons for junctional injuries, and resuscitative endovascular balloon occlusion of the aorta (REBOA) for noncompressible trauma, while vascular shunts are the cornerstone for the urgent restoration of blood flow. Conclusion: Regarding vascular trauma, “damage control” surgery refers to obtaining expeditious bleeding control and restoring organ/limb perfusion while avoiding time-consuming surgical techniques. Clinical significance: When damage control in vascular trauma is required in environments with limited resources, such as geographically isolated locations or the battlefield in war zones, difficulties are often enhanced by the unavailability of devices, instruments, and surgical expertise in treating these potentially lethal injuries. This paper presents practical suggestions for these situations.

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