Damage Control in Vascular Trauma

Damage control management of vascular trauma involves stopping the hemorrhage and facilitating resuscitation. This review seeks to inform providers on the advances of prehospital care, improved understanding of resuscitation, and increasingly complex decision-making regarding definitive repair.

Recent emphasis on tourniquets has improved extremity hemorrhage control. Advances in hemostatic agents and junctional tourniquets are being explored for traditionally “non-compressible” hemorrhage. Resuscitative endovascular balloon occlusion of the aorta (REBOA) remains controversial. Whole blood or 1:1:1 blood-product-ratio resuscitation can correct physiology, preserving life and limb. Surgical options include primary repair or interposition grafting, shunting, or ligation. Shunting and proper fasciotomy remain useful tools for damage control and limb salvage.

Damage control in vascular trauma remains a life-saving and limb-saving strategy. Modern prehospital treatment may increase the number of patients who arrive alive to the trauma bay. Appropriate surgical judgement and perioperative principles remain the cornerstones of individualized management in the modern era.