Commentary on 'Venous trauma: new lessons and old debates'.

摘要

Venous trauma is a very important and often overlooked aspect of trauma care in general and vascular trauma in particular. In this very nice overview performed by Drs Qui and Gillespie, the incidence, diagnosis, major treatment modalities, and future treatments are discussed. From our perspective, the major points are as follows: 1. The majority of venous injuries involve extremity injuries, both in military and civilian incidents. 2. Concomitant arterial injuries are more common than not, and in some series they occur in more than 85% of cases. 3. Duplex imaging is a good modality to make the diagnosis, followed by contrast venography and/ or spiral computed tomography scanning. 4. Treatment modalities vary and include ligation, repair, and reconstruction. 5. Reconstruction should not be attempted in unstable patients and in injuries below the knee. 6. Patient selection is key to good results; common iliac vein injuries, common femoral vein injuries, and popliteal vein injuries should be repaired in stable patients. 7. Endovenous approaches are being investigated and may be an advance for lesions in inaccessible locations, such as the inferior vena cava behind the liver.