“Life over limb”—that was one of the key messages to emerge from the VAM 2024 SVS Women’s Section session that placed a lens over vascular trauma treatment. Misty Humphries, MD, associate professor of surgery at University of California Davis in Sacramento, California, who was covering mangled extremities and providing tips from the frontlines of a level-1 trauma center, underscored the point that maintaining life was always paramount.
“I don’t really implement treatment the way a vascular surgeon would—a lot of times I’ll do things as a trauma surgeon would,” she said. Humphries walked through the definition of a true mangled extremity, with severe damage being caused to at least three of the four: bone, vessels, nerves and/ or soft tissue. Humphries shared her salvage vs. amputation decision tree and discussed the multidisciplinary evaluation that needs to take place before a decision is made. Humphries covered different orthopedic cases and studies that aided in her trauma training and decision-making on whether to amputate an extremity over time. She wrapped up her time at the podium by sharing practices she had adapted over time to help with extremity trauma.
The session, entitled Vascular Trauma: What I Need to Know in the Middle of the Night, was the brainchild of co-moderator Erica L. Mitchell, MD, professor and chief of vascular and endovascular surgery at the University of Tennessee Health Science Center in Memphis, Tennessee. “The idea was inspired by the paucity of vascular trauma literature as well as the rising interest of vascular trauma in the medical field,” she explained. “There needs to be vascular surgical engagement in the care of these vascular trauma patients, so I wanted to host a session that could make vascular surgeons more confident in providing that engagement.”
The session brought together a number of leaders in the vascular surgery arena who have extensive experience with vascular trauma cases. Manuel Garcia-Toca, MD, a vascular surgeon at Emory University in Atlanta, Georgia, discussed managing trauma to the head and neck vessels. “The neck has so many vital structures in a really confined space,” he said. “It is challenging when you get a phone call in the middle of the night when there’s a patient with a neck injury. You don’t know if the patient will have to go to the OR [operating room], and that is a tough call to make from the phone.”
A vast majority of the calls will be from blunt injuries to cervical vessels—injuries that, according to Garcia-Toca, received a lot of awareness in the 90s because people were having strokes as a result. “So, you need to review the CAT scan from home to make the call,” he said, stressing the importance of acting within the first 72 hours to prevent a stroke. Garcia-Toca underlined the importance of establishing vascular trauma protocols at institutions and offered “pearls in the middle of the night”: that most blunt cerebrovascular injury injuries should be managed by antithrombotic therapy, encouraging the use of computed tomography angiography (CTA) to guide therapy unless there are hard signs of a vascular injury.
Elsewhere, Luc Dubois, MD, associate professor in the Division of Vascular Surgery at University of Western Ontario in London, Ontario, Canada, explored abdominal vascular trauma, highlighting endovascular vs. open procedures for abdominal aortic injuries. Sadia Ilyas, MD, a vascular surgeon at MedStar Heart and Vascular Institute in Washington, D.C., covered thoracic vascular injuries, discussing how she categorizes traumas into blunt or penetrating traumas, and shared the grading scale from the 2011 SVS Clinical Practice Guidelines. Ilyas also walked through how to manage patients with blunt aortic trauma and how to conduct surveillance. Andrea Lubitz, MD, assistant professor of surgery in the Division of Vascular and Endovascular Surgery at the Lewis Katz School of Medicine at Temple University Hospital in Philadelphia, spoke on a “rare but complex problem”: IV drug use-associated pseudoaneurysms. She described the nature of IV drug use (IVDU), its management and gave an overview of the current literature.
The session wrapped with a talk from Pedro Teixeira, MD, associate professor of vascular surgery at the University of Texas at Austin Dell Medical School, who discussed the rarity of vascular surgeons seeing trauma patients for follow-ups.
