![]() ![]() Soft signs include the following: bleeding at the scene, reduced pulse, non-expanding hematoma, injury close to a blood vessel or bone fracture. Hard signs include the following: bleeding from the artery, absence of pulse, pulsation or haematoma, bruit or thrill and ischemia-related signs that are increasing in size. The signs of vascular injury in the limbs can be classified as either “hard” or “soft” signs. Although the clinical examination may identify vascular trauma, there is a diagnostic dilemma if the bleeding source cannot be identified. Damage to major vessels will lead to haemorrhage and will clinically manifest as hypotension or shock. The main clinical manifestations of vascular injury are haemorrhage (commonly from truncal vascular injuries) and ischemia (typical of peripheral arterial injuries) and, to a lesser extent, stroke after cervical vascular damage. However, technological advances such as endovascular aortic stenting, and the fact that anticoagulation is not absolutely contraindicated in traumatic brain injury, means many patients can survive with a good quality of life. Historically, these injuries have been associated with poor prognosis. Although rare, aortic/brain injury management can be challenging where there is a need to anticoagulate the patient but brain injury precludes the anticoagulation. Management of a polytrauma patient is very challenging, and the treating clinician is often faced with the dilemma of deciding which injury should be prioritised. For a successful outcome, teamwork, communication among caregivers, sound knowledge of vascular anatomy and understanding of the appropriate sequence of diagnostic modalities are crucial. The experience gained during periods of war has made limb salvage a rule rather than an exception. To avoid loss of life or limb loss, diagnostic investigations should be undertaken synchronously with the resuscitation process. ![]() Vascular injury is highly morbid, and under certain conditions it can lead to rapid exsanguination and death. Trauma is the leading cause of unexpected mortality in persons under the age of 44 years and represents a huge burden on society in terms of money spent for immediate and long-term care. SA contributes to the increasing burden of road traffic collision (RTC)-related mortality. In South Africa (SA), there are over 30,000 trauma-related deaths annually, which is equivalent to that of two-thirds of the whole trauma death rate for Europe. At times, more than one investigation may be required. The associated injury also plays a crucial role in deciding the imaging modalities. Conclusion: This paper highlights the significance of timely and appropriate use of diagnostic tools for traumatic vascular trauma to save life and to preserve the limb. The various diagnostic tools to individualise the investigation are discussed. The systematic approach in terms of clinical diagnosis and imaging is crucial in order save life and preserve the limb. They are characterised by multiple injuries, the dilemma of the diagnostic approach, timing of intervention and higher risk of limb loss or death. Results: Traumatic vascular injuries are associated with limb loss or even death. The focus is the epidemiology of vascular injury and diagnostic approaches to it in the context of polytrauma. ![]() The factors influencing the diagnostic approach are highlighted. Methods: Comprehensive literature review of current diagnostic approaches to traumatic vascular injury in the context of polytrauma. The mechanisms of vascular injury in the setting of polytrauma are either blunt, penetrating or a combination of the two. Independent predictors of outcome include mechanism of injury, associated injuries, and time from injury to definitive care. Vascular injury is highly morbid it can lead to rapid exsanguination and death, posing a threat to both life and the limb. Trauma is the main cause of unexpected demise in individuals below the age of 44 years and represents a huge burden on society. Background: Polytrauma is understood as significant injuries, occurring at the same time, to two or more anatomical regions (the ISS regions) or organ systems, with at least one of the injuries considered as posing a threat to life. ![]()
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