Damage Control Strategies For Vascular Injuries – A Report From The Amazon

Patients may sustain vascular injuries in rural areas or isolated locations, which are very common in the vast area of the Amazon rainforest. In situations like this, patients may take many hours, or even days, to get access to hospitals capable of dealing with these potentially lethal injuries, arriving in severe conditions that may require damage control strategies. Among the currently available techniques for damage control resuscitation and damage control surgery, the endovascular balloon occlusion of the aorta (REBOA) and temporary vascular shunts play an important role, but appropriate devices are often unavailable; in such scenarios, surgeons’ expertise on how to improvise devices, using more accessible materials, can be lifesaving. This paper presents a case of femoral vessel injury in a patient who required REBOA and vascular shunt improvisation; discussions regarding possible improvisation strategies are provided and technical steps on how to implement them are described.