engleski

Europe: Croatia

In Croatia (4, 500.000 inhabitants) vascular trauma is rare: the number of reported major vascular injuries does not exceed 90 injuries per year including head, trunk and extremities. The data from homeland war (1991-1995.) revealed a much higher incidence of vascular injuries, especially those to the extremities. Secondary care in Croatia is presented through general hospitals and university (clinical) hospitals. All clinical hospitals have vascular surgery divisions ; major vascular injuries are transported and managed in clinical hospitals. The system of hospital trauma care predicts that the trauma surgeon (being available 24/7 in hospital) is the first on call when the injured patient arrives. The vascular surgeon is always available on-call and if necessary, he takes over the management of vascular injury. In polytraumatized patients or in cases of complex traumatic injuries the muti-detector CT scan (MDCT) is used without, or with contrast angiography if necessary to assess for vascular injury. When dealing with an isolated vascular injury, digital subtraction angiography (DSA) is performed if possible and recognized as the gold standard. The treatment strategy implies urgent vascular reconstruction: primary reconstruction or the use of conduit – preferably vein graft. In some cases, ligation of the vessel, or even amputation is indicated. The treatment strategy often requires urgent vascular reconstruction using the technique of: primary repair or the use of a conduit (preferably autogenous vein) interposition or bypass grafting. In some cases, ligationm of the vessels, or even primary amputation is indicated. Trauma surgery training in Croatia includes three months of vascular surgery education thus potentiating the trauma surgeon to manage vascular injury capably. At a minimum, the objective of such training is to allow the trauma surgeon to be able to reconstruct a major vascular injury with primary repair an possible with conduit interposition grafting depending on the individual's skills and experience.

vascular injury ; diagnostics ; surgery ; reconstruction ; education

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