Uncontrolled bleeding is the most immediate and visible sign of vascular injury. If a major artery is torn or ruptured, the loss of blood can be rapid and dangerous. The first goal is to stop the bleeding.
This can be done by:
- Open Surgical Repair, where the artery is directly exposed and the bleeding point is controlled with sutures or grafts
- Ligation, where small or non-critical bleeding vessels are tied off
- In select cases, minimally invasive methods may be used to block the bleeding artery and stabilize the patient
The method depends on the location of the artery, the patient’s condition and the extent of the injury.
If an artery has been cut, torn, or crushed, simply stopping the bleeding is not enough. Blood flow to the limb must be restored to avoid long-term damage.
Repair techniques include:
- Primary Repair: Stitching the artery directly if the ends are clean and not under tension
- Interposition Grafting: If a section of the artery is damaged, it is removed and replaced using a vein graft (usually taken from the leg) or a synthetic graft
- Bypass Grafting: If repair is not possible at the site, a new route is created using a graft to restore blood flow
The key to success is timing – the earlier the repair is done, the better the chances of salvaging the limb.
In some cases, the injury causes swelling inside the limb muscles, especially when blood supply is cut off for a few hours. The pressure builds up inside the closed muscle compartments, squeezing nerves and blood vessels. This is called compartment syndrome.
If not treated immediately, it can lead to:
- Muscle death
- Permanent nerve damage
- Limb loss
The treatment is an urgent fasciotomy, a surgical procedure in which the skin and underlying fascia are cut open to relieve pressure. This restores circulation to the muscles and helps prevent irreversible damage.
One of the major goals in vascular trauma is to prevent amputation. With good planning and prompt vascular surgery, even severely injured limbs can often be saved.
Limb salvage involves a combination of:
- Bleeding control
- Arterial repair or bypass
- Fasciotomy when needed
- Wound care and infection control
- Fracture fixation in coordination with orthopedic teams
Saving the limb not only preserves function but also gives patients the confidence and quality of life they deserve after trauma.
- Removal of the entire saphenous vein via open surgery.
- Rarely done today due to the success of endovenous techniques.
- Reserved only for select cases where endovenous access isn’t possible.