Implications of Vascular Trauma in Brazil

Abstract

Like elsewhere in the world, vascular trauma is the most challenging aspect of care in the multiply injured patient in Brazil, a country of approximately 190 million people. The complexity of vascular injury, including its propensity to result in shock or ischemia and its tendency to be associated with injuries to other tissues or organs, requires a multidisciplinary approach focused on life- and limb-saving maneuvers. In Brazil, urban violence, automobile crashes, and work-related accidents are responsible for most instances of vascular injury. In the recent decade, injury from urban violence has plateaued or decreased when considered in the context of continued population growth. The evaluation, diagnosis, and management of vascular trauma in Brazil varies widely depending on whether or not the patient is treated in a remote rural setting or in a better equipped urban medical center. In the metropolitan areas of Brazil, the triage, diagnosis, and management of vascular injury is similar to that in other developed countries of the world. In these settings, modern imaging modalities such as multislice contrast CT scanning and contrast angiography are useful adjuncts to the physical examination. For organizational and teaching purposes, vascular trauma in this international perspective essay is considered in the following anatomic distributions, each with slightly different diagnostic and management considerations: (1) cervical or carotid, (2) axillo-subclavian, (3) thoracic, (4) abdominal, and (5) extremity. Whereas the majority of vascular injury is managed via an open operative approach, the use of endovascular techniques is common in the metropolitan centers throughout the country. In these instances, stent grafts are often used to treat or ""seal"" vascular disruption in anatomically challenging areas to reach vessels such as those in the thorax and thoracic outlet. In Brazil, challenges exist as to the ""best training paradigms"" to prepare trauma and vascular surgeons. However, a number of Brazilian medical centers and emergency medical systems, along with meetings and courses offered by professional societies such as the Brazilian trauma society Sociedade Brasileira de Atendimento Integrado ao Politraumatizado (SBAIT), have led to an increased emphasis on the importance of all aspects of trauma care in the country. © 2016 Elsevier Inc. All rights reserved.