The body is made up of several transport systems, including the arterial, venous, and lymphatic systems as well as the neurologic system. Injury to any of these systems may occur and, almost always, when an injury occurs to an area, it affects more than one system. Certainly, the venous system is subject to damage whenever an injury or traumatic experience occurs. The trauma may be minimal and therefore the injury may be minimal; however, the trauma may seem simple, and the injury may be severe but masked when no major outward signs are noted. Venous trauma may include injury to the endothelium, the venous musculature, or the adventitia of the vein. Such trauma may be compression (i.e., crushing) in nature as well as transectional (both partial and complete) and linear as well as cross-sectional. Each of these injury types may require a different therapeutic approach.
Trauma per se is a leading cause of death in both the civilian as well as the military arena. It is particularly noted in young individuals and most commonly is seen in accident-prone individuals such as little children, teenagers, and young adults learning and experimenting with different ways of life. The male population is more commonly involved. The frequency of significant venous injuries is much less than the frequency of arterial, musculoskeletal, or truncal injuries. This is partly because venous injuries are not of primary or major concern in most traumatic situations. Thus, in general, trauma, or vascular surgeons' reporting of venous injuries is limited because the treatment of patients with such injuries may be limited. Most significant and reported venous injuries occur in association with other injuries such as arterial, truncal, orthopedic, or gastrointestinal (GI) injuries (Figures 33-1). Isolated examples of venous trauma remain infrequent and are seldom reported.
Severe crush injury to the lower extremity and pelvis with multiple structure involvement.
Table 33-1 lists the various types of venous trauma. As presented in the table, there are three main causes of significant venous injury. By far, the most common of these in the civilian population is the blunt injury in which a significant force may strike the abdomen, chest, head, or extremity (Figures 33-2 and 33-3). The injury may cause interruption, contusion, or compression of the venous structures. The swelling in association with the trauma may limit the diagnosis of a venous injury for some time or may totally obscure the injury when observation and time lapse allow healing. Penetrating injuries are frequently associated with perforation of other structures, which take priority in the treatment scheme. In certain communities, gunshot wounds and knife stabbings are more prevalent than in others.