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Aim: The aim of this work is to illustrate the diversity of vascular injuries in terms of vascular segments or body regions, accident mechanisms and specific patient constellations., Method: A representative case collection was compiled based on current and relevant scientific references in PubMed, own clinical experiences, vascular surgical and novel image-guided interventional options., Results: The diagnostics of vascular injuries in the context of trauma and fractures are based on a thorough physical examination. In addition, the hard and soft signs preferred by the Western Trauma Association should be included in the decision. Doppler ultrasonography examination is the safest and gentlest noninvasive examination procedure for a suspected vascular injury due to repeatable and comparative measurements. The stabilization of a fracture, ideally using an external fixator, should be performed before vascular reconstruction whenever possible, unless massive bleeding, hypovolemic shock or a rapidly spreading hematoma represent an immediate indication for surgery. In pediatric supracondylar fractures, avascular injury without relevant ischemia has frequently been described (pink pulseless hand). In this case, the fracture should first be reduced as the pulse often recovers. Due to the increasing availability, good technical handling and high technical success rate as well as the relatively limited interventional trauma, endovascular treatment of traumatic vascular injuries has become widely accepted. Traumatic aortic ruptures are associated with a high mortality even at the accident site. Rapid endovascular treatment using a stent prosthesis significantly increases the injured person's chances of survival., Conclusion: Vascular injuries in connection with fractures or multiple injuries require interdisciplinary cooperation between the specialties involved., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: U. Barth, S. Piatek, M. Stojkova, H. Krause, F. Meyer und Z. Halloul geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen Studien an Menschen, aber nicht an Tieren durchgeführt. Für die aufgeführte Studie gilt die angegebene ethische Richtlinie. Es liegt kein Bildmjaterial über Patient/-innen vor, die darüber zu identifizieren sind., (© 2024. The Author(s).)

Vascular injuries and hemorrhaging are serious potential complications in the management of patients with blunt abdominal trauma. The treatment depends on the extent and localization and can range from surveillance to endovascular treatment up to open surgery. The keys to success include the focused assessment with sonography for trauma (FAST) management and timely decision making. Abdominal vascular trauma continues to be a difficult problem and open and endovascular techniques continue to evolve in order to address this complex disease process., (© 2023. The Author(s).)

Background: Traumatic aortic injuries (TAI) are rare injuries in blunt thoracic trauma, which have a high morbidity and mortality. Rapid and accurate diagnosis as well as the correct choice of treatment are elementary for patient survival., Objective: Determination of the current standards for diagnostics of TAI in the acute trauma setting and evaluation of the current guidelines for treatment., Material and Methods: A literature search was carried out for articles describing diagnostics of TAI. Furthermore, the guidelines for treatment and follow-up of TAI were summarized., Results: Despite the low specificity conventional chest X‑ray is still named in the literature as initial diagnostic procedure. Primarily, computed tomography (CT) should follow as the method of choice for diagnostics and treatment stratification due to the high sensitivity and specificity. Thoracic endovascular aortic repair (TEVAR) is recommended by all guidelines as first line treatment of higher grades of TAI (grades II-IV) and has replaced open surgery in most cases., Conclusion: After rapid diagnosis and classification of TAI with CT, in most cases TEVAR has become the preferred treatment over open surgery., (© 2021. The Author(s).)

Background: Approximately one third of all traumatic peripheral artery injuries affect the upper extremities, while two thirds involve the arteries of the lower extremities. Historically, these injuries were treated by open surgical repair. Nowadays, interventional treatment, such as embolization or stent grafting are increasingly used to treat peripheral artery injuries., Objective: Determination of the current state of interventional treatment options for injuries of peripheral arteries., Material and Methods: Selective literature review on the current state of interventional management of peripheral artery injuries., Results: Although scarce, the available data confirm the efficacy of interventional techniques for managing peripheral artery injuries; however, despite improvements in treatment techniques and interventional devices, not all patients are equally well suited for endovascular or open surgical treatment. Consequently, a multidisciplinary decision on the best treatment has to be made on a case by case basis., Conclusion: According to the promising clinical data, interventional treatment should be considered more often. Diagnostic algorithms need to be adapted accordingly., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

History and Clinical Finding: In a 67-year-old female patient with upper abdominal pain, computed tomography showed a partly calcified swelling of the pancreatic head and wall thickening of the duodenum., Examinations: Inpatient physical examination findings were normal. Laboratory showed increased pancreatic enzymes (amylase 210 U/l [Standard range: 28-100 U/l], lipase 2115 U/l [Standard range: 23-300 U/l]) and inflammation values (CRP 11.7 mg/l [Standard range: < 5.0 mg/l]), otherwise largely normal laboratory parameters. In the esophago-gastro-duodenoscopy, biopsy of swollen, partly stenosing mucous membrane areas in the duodenum was performed., Diagnosis: Histology revealed partial erosive duodenitis, no evidence of a malignant tumor. If chronic calcifying pancreatitis was suspected, a sonographically guided percutaneous biopsy of the pancreatic head was performed to exclude a tumor., Treatment and Course: Post-biopsy, the patient developed abdominal pain and temporary circulatory instability with nausea/vomiting and a drop in Hb to 7.5 g/dl [Standard range: 12.3-15.3 g/dl]. The sonographic suspicion of a retroperitoneal hematoma was confirmed by computed tomography. The cause was a haemorrhage from a renal artery perforation on the right side, which could be stopped by immediate angiographic intervention with a covered stent., Conclusion: After percutaneous biopsy, vascular perforation must always be considered. Computed tomography provides a reliable and quick diagnosis. Minimally invasive percutaneous insertion of a covered stent is the therapy of choice in the case of a renal artery accessible to stents., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The underlying case report describes the successful endovascular prevention of an aortic injury by a bone cement skid after kyphoplasty. The intervention was performed in order to prohibit fatal aortic rupture or embolisation and underlines the role of vascular surgery techniques in interdisciplinary clinical networks.

Clinical Issue: In recent years interventional radiology has significantly changed the management of injured patients with multiple trauma. Currently nearly all vessels can be reached within a reasonably short time with the help of specially preshaped catheters and guide wires to achieve bleeding control of arterial und venous bleeding., Standard Treatment/treatment Innovations: Whereas bleeding control formerly required extensive open surgery, current interventional methods allow temporary vessel occlusion (occlusion balloons), permanent embolization and stenting., Diagnostic Work-Up: In injured patients with multiple trauma preinterventional procedural planning is performed with the help of multidetector computed tomography whenever possible., Performance: Interventional radiology not only allows minimization of therapeutic trauma but also a considerably shorter treatment time., Achievements: Interventional bleeding control has developed into a standard method in the management of vascular trauma of the chest and abdomen as well as in vascular injuries of the upper and lower extremities when open surgical access is associated with increased risk. Additionally, pelvic trauma, vascular trauma of the superior thoracic aperture and parenchymal arterial lacerations of organs that can be at least partially preserved are primarily managed by interventional methods., Practical Recommendations: In an interdisciplinary setting interventional radiology provides a safe and efficient means of rapid bleeding control in nearly all vascular territories in addition to open surgical access.