Trauma is the third leading cause of avoidable death in the UK, and globally is responsible for 5.8 million deaths per annum.
The incidence of vascular injuries in major trauma patients varies from 4.4% in civilian centres up to 15% in military conflicts in Iraq and Afghanistan.
Vascular injuries are the sequelae of both blunt and penetrating trauma mechanisms, occur in truncal and peripheral body areas, and in vessels of any size. Arterial damage carries high mortality due to exsanguination and distal tissue ischaemia, with management strategies that are well documented.
Venous injuries are less common: an observational study at one London Major Trauma Centre demonstrated 73 venous injuries over five years, half of which presented in association with arterial injury.
Although a low flow system, left untreated, venous injuries carry short- and long-term morbidity, including reduced venous outflow, compartment syndrome, thromboembolism, venous hypertension and the associated post-thrombotic syndrome.
In high volume veins, haemorrhage is often fatal: iliac, portal and mesenteric vein injuries have a mortality of 50–70%, and 30–50% of isolated inferior vena cava (IVC) injuries succumb in the pre-hospital setting.