Contemporary Strategies in the Management of Civilian Vascular Trauma

Trauma remains the leading cause of death in the 15- to 44-year-old age group in the Western World, as a consequence of a motor vehicle accident, unintentional injury, assault, terrorism, homicide, and suicide. The distribution of civilian vascular trauma has not changed much throughout the decades; penetrating trauma still predominates, while blunt trauma constitutes the minority. Vascular trauma has always been a challenge as it is associated with either high mortality or high limb loss rates. Military experience and new technologies, have altered the overall management of both peripheral and truncal vascular trauma. While open surgical management has always been the gold standard, the use of endovascular techniques is becoming more prominent for selected indications. Alongside, damage control, novel hemostatic agents, transfusion protocols as well as evolution in the intensive care field have shifted management towards more sophisticated strategies. As the future unfolds, the benefits and detriments of these contemporary strategies are constantly reevaluated targeting optimal care, minimal limb and life losses.