Damage control in vascular injury

The highest goal in damage control surgery is to stop the bleeding. Major injuries to the vessels therefore pose the major challenge in the damage control approach. Optimal care can be provided in combination with receiving and treatment rooms with CT, operative and endovascular capabilities. For patients in extremis, REBOA is a new technique to stabilize patients preventing the need for emergency room thoracotomy. General damage control management techniques for vascular injuries comprise temporary closure by tourniquets, compression devices, and intra- as well as extravascular balloons. Intraoperatively manual compression and stick swabs can be used for temporary control of the bleeding. For more definitive closure, ligation as well as endovascular coiling can be used. For flow restoration temporary indwelling stents can be used, whereas for more permanent use, both anatomic and extra-anatomic stent grafting are used as a permanent solution.