Ballistic Vascular Injury Management: Hemorrhage Control, Shunts and Limb Salvage

Ballistic vascular trauma is a race against two major threats: hemorrhage and ischemia. Professor David Hampton uses real trauma cases to show how decisions made from the point of injury through the operating room can determine whether an extremity—and sometimes the patient—can be saved.

The lecture moves from tourniquets, wound packing and rapid vascular control to temporary intravascular shunts as a key damage-control tool. Clinical examples cover carotid, axillary, brachial, superficial femoral and popliteal injuries, with practical discussion of surgical exposure, proximal and distal control, Fogarty thrombectomy, vein grafting and fasciotomy.

Several cases highlight details that are easy to miss in textbooks: using Foley balloon tamponade for penetrating neck wounds, recognizing arterial injury through associated neurologic findings, choosing which end of a shunt to insert first, and avoiding shunt-related intimal dissection.

The Q&A extends the discussion into difficult real-world decisions—when vascular injuries may be observed, whether major venous injuries should be repaired, what happens after delayed revascularization, anticoagulation around temporary shunts, reperfusion injury, and the point at which limb salvage becomes a multidisciplinary decision.