14 - Endovascular to Extracorporeal Organ Support for Vascular Trauma and Shock

Abstract

Mechanical trauma to major arterial vessels often leads to significant vascular compromise to large tissue beds which then results in the immediate reduction in oxygen delivery, cellular dysoxia, and cell death. This occurs in varying degrees to every anatomic region and organ in the body. The degree and extent of tissue injury directly correlates with the duration of the ischemic insult. As major arterial vessels are repaired and blood flow restored via the variety of endovascular or open techniques described in other chapters throughout this textbook, varying degrees of metabolic and end-organ consequences can be expected and are widely characterized as “ischemia-reperfusion” injury. Recent disruptive advances in the field of vascular surgery in the form of endovascular occlusion techniques for hemorrhage control and the wide variety of endovascular repair options utilized have pushed the physiological limits of what is humanly possible to sustain life after severe injury. As such, an increasing number of trauma patients are surviving deeper into the hospitalization more metabolically deranged than ever with varying degrees of end-organ injury. Fortunately, the field of critical care has also experienced an equally formidable leap in medical innovation in the form of various extracorporeal organ support technologies. This chapter will review the latest advances and techniques to assist vascular surgeons in the management of metabolic derangements and organ failure, with a focus on renal and lung support.