Ligation: An Alternative for Control of Exsanguination in Major Vascular Injuries

BACKGROUND Temporization in the management of patients in extremis has gained acceptance in trauma surgery. Resection, without anastomosis, in major visceral injuries followed by delayed reconstruction has been successful. METHODS To evaluate this approach in patients with substantial vascular trauma, we reviewed our experience of five patients with major vascular injuries that were ligated as a temporizing procedure during a 58-month period. If the patient was hypothermic, acidotic, and potentially or actually coagulopathic with significant blood loss, achieving expeditious hemostasis was the primary consideration. After hemodynamic resuscitation, warming, and correction of the coagulation profile, if necessary the patients were returned to the operating room for definitive reconstruction. RESULTS All patients survived; only two required subsequent vascular reconstruction. CONCLUSIONS The prompt control of hemorrhage must be the first objective of treatment in critically injured patients. Ligation of major vessel injury is a therapeutic alternative as part of the "damage control" philosophy.