Management of Vascular Injury: A Comprehensive Review of Current Concepts and Advances

INTRODUCTION Vascular injury is among the most time-critical emergencies in trauma surgery. Despite representing only 1 to 3% of civilian trauma admissions, it carries a disproportionate burden of mortality and permanent disability, with hemorrhage remaining the leading preventable cause of early trauma death. This review critically evaluates current evidence for the diagnosis and management of vascular injuries across anatomical regions, appraises open and endovascular strategies, and identifies ongoing controversies and evidence gaps in contemporary practice. MATERIAL AND

Methods

A narrative review of published literature was performed using MEDLINE, Embase, and the Cochrane Library. Priority was given to prospective studies, multicenter registries, systematic reviews, and current clinical practice guidelines published between 2000 and 2024. Landmark historical studies were included where they defined foundational practice.

Results

Advances in damage-control resuscitation, CT angiography, endovascular technology, hybrid operating rooms, and resuscitative endovascular balloon occlusion of the aorta (REBOA) have substantially improved outcomes. However, evidence for several management decisions remains largely observational. Open repair retains primacy for most peripheral arterial injuries, while thoracic endovascular aortic repair (TEVAR) has supplanted open surgery for blunt thoracic aortic injury in hemodynamically stable patients. Critical appraisal reveals important controversies regarding REBOA deployment, optimal conduit selection, venous injury management, and the role of endovascular therapy in resource-limited settings.

Conclusion

Prompt recognition, multidisciplinary coordination, and individualized selection of open or endovascular repair remain the cornerstones of vascular trauma management. Future progress depends on high-quality prospective registries, standardized outcome reporting, and equitable access to endovascular technology.