Damage control for vascular injuries.

Circumstances that call for the use of damage control techniques involve multiple and complex injuries associated with significant hemodynamic compromise. This setting requires the rapid assessment and prioritization of injuries so that the greatest threat to survival may be addressed as soon as possible. Major vascular injuries are a common source for exsanguinating hemorrhage and must be addressed in an expeditious manner. Ischemia takes a lower priority than hemorrhage but should be addressed early unless doing so threatens systemic viability. Ligation, balloon catheter occlusion, and temporary intraluminal shunt insertion are the commonly useful techniques for temporizing the danger while plans are formulated for definitive reconstruction at a later time under better operative conditions. Contamination and infection are unfortunate realities in the damage control arena and are dealt with when feasible. In such circumstances, which are associated with a very high risk of morbidity and mortality, it is difficult to discern the outcome effects of specific injuries from the associated treatment techniques. Trends for improved survival of otherwise highly lethal injuries in institutions where these techniques are used provide at least presumptive testimony to their value. Large clinical series and supportive experimental data are not readily available to verify the physiologic benefits of the damage control approach. However, the increasingly popular use of these techniques in both urban and rural trauma management provides at least some hope for survival of traditionally devastating and frequently lethal injuries.