Management of Vascular Trauma

Course Overview:

A video presentation, prepared and translated into Armenian and Russian, was shown to all course participants on the first day of the five-day course. Following the video, a general question and answer session was held to assess the level of understanding of course participants and to determine the educational needs of the group.

Dry Laboratory:

Suture boards, suture material, and vascular prostheses were used to demonstrate basic vascular suture techniques and various types of anastamotic methods. Mock vascular injuries were simulated on prosthetic grafts and methods to repair such injuries were demonstrated. These included: resection with end-to-end anastamosis; primary repair by lateral suture technique; patch angioplasty; interposition grafting; and bypass grafting.

Slide Presentation:

The material used to create the video was shown in slide format. This allowed for a much slower pace and time to re-emphasize key points. Questions were entertained after each slide to be sure that participants understood the material.

Use of the Doppler Instrument:

The principles of Doppler technology were demonstrated. In addition, the clinical use of the Doppler for measurement of blood pressure to calculate an ankle brachial index was stressed. Differences between arterial and venous sounds were demonstrated.

Clinical Case Presentation:

A variety of slides depicted actual extremity vascular injuries or angiograms with vascular injuries. Key points were stressed during the presentation, as: clinical assessment of the patient; resuscitation; operative therapy; and post-operative complications.

Final Examination:

Three stations were set up at which each participant was expected to demonstrate learning. They included:

• Doppler Station:
  At this station, the participant was asked to measure a blood pressure with the Doppler instrument and to calculate an ankle brachial index.
• Clinical Case Station:
  At this station, slides were presented depicting an injured extremity or an abnormal arteriogram. The examinee was asked either to make a diagnosis or initiate therapy.
• Dry Laboratory Station:
  The examinee was asked to perform various types of anastamoses. In addition, mock vascular injuries on prosthetic material were simulated and examinees were asked to make appropriate repairs.