A 71-year-old male patient who was undergoing regular hemodialysis through the right native forearm arteriovenous fistula (AVF) for underlying end-stage renal disease presented to the emergency room (ER) complaining of pain in the right shoulder due to trauma. The patient was diagnosed with a surgical neck fracture of the right humerus on examination, and open reduction and internal fixation (ORIF) was performed on the third day of admission. During the operation, bleeding occurred due to damage to the distal cephalic vein. In order to maintain the native AVF, the trauma vascular surgeon was contacted, and primary lateral repair was performed simultaneously. After the operation, hemodialysis was attempted through the AVF according to the regular dialysis schedule and hemodialysis proceeded without any problems.

A 37-year-old male patient without underlying disease presented to the ER complaining of damage caused when his left lower extremity (LE) was caught between a forklift and a railing. The patient was diagnosed with a left tibiofibular open fracture with a popliteal artery injury, and emergency surgery was performed. According to the surgical findings, popliteal artery transection was confirmed, and segmental interposition using the reversed greater saphenous vein was performed. After vascular surgery, the orthopedic surgery team took over the operation and performed ORIF. After surgery, there was sudden bleeding at the site of vascular surgery. As a result of revision, the popliteal vein injury, which was intact, was confirmed. The popliteal vein was transected, and proximal and distal ligations were performed in a situation where approximation was not possible. The patient had substantial muscle mass and the ischemia time was approximately 4 hours. The calf was firm to palpation at the time of revision and prophylactic fasciotomy was performed to prevent progression to compartment syndrome. After 12 days, external fixation conversion was performed, and 16 weeks of wound care were required in collaboration with a plastic surgeon.

A 30-year-old male patient, complaining of abdominal pain following a traffic accident (TA), presented to the ER. The patient was admitted to the ICU due to the possibility of damage to the abdominal wall and internal organs and was clinically followed. A central line insertion was attempted through the right internal jugular vein (IJV) during resuscitation in the ER. An arterial puncture occurred during the attempt to insert a central venous catheter, and the procedure was stopped. No additional complications were observed at the site. On the second day of hospitalization, the patient complained of abrupt abdominal pain, suggesting peritoneal irritation, and emergency exploratory laparotomy was performed. According to the surgical findings, ischemic sigmoid colon perforation caused by damage to the sigmoid mesocolon was diagnosed, and a Hartmann procedure was performed. On the day after surgery, thrill and bruit were observed in the patient’s right neck, and arterial flow in the jugular vein was confirmed by bedside Doppler ultrasonography. An additional examination was planned for a suspected iatrogenic AVF. A subclavian artery to IJV AVF was confirmed by computed tomography angiography of the neck (Fig. 1A). Conventional angiography was performed to control the fistula tract (Fig. 1B). After selecting the tract, multiple coil embolization was performed. The final angiography after the procedure confirmed that there was no arterial flow into the IJV (Fig. 1C). There were no additional vascular complications on subsequent follow-up.

A 75-year-old female patient who was diagnosed with a right femur fracture, multiple pelvic fractures, bladder injury, and a fifth lumbar vertebral body fracture due to a pedestrian TA was transferred from a local hospital to the trauma center through the ER for further evaluation and treatment. The patient was admitted to the ICU, and closed reduction and internal fixation for the femur fracture and surgery for the pelvic fractures were performed on the seventh and 11th days after admission, respectively. Postoperatively, there were findings of suspected ischemic injury in the right LE. The initial findings were suspicious for underlying vascular disease, but additional examinations were planned according to the progressive findings. On computed tomography angiography of the LE, segmental arterial occlusion was found at the site of the femur fracture, and findings adjacent to the orthopedic surgical site were observed (Fig. 2A). Therefore, additional surgery was performed, which confirmed that the superficial femoral artery was entrapped by two of the surgical wires used during closed reduction and internal fixation (Fig. 2B). The surgical wires were removed and segmental interposition using a prosthetic graft for the injured superficial femoral artery was performed. There were no additional vascular complications, although the patient did show foot drop during the recovery process, a possible sequela of ischemic peripheral nerve damage.

An 83-year-old female patient presented to the ER complaining of multiple injuries caused by a pedestrian TA. The patient was admitted to the ICU after being diagnosed with a seventh cervical vertebral body fracture, multiple rib fractures, sternum fracture, multiple pelvic fractures, left tibiofibular fracture, and left shoulder fracture. On the 4th day of admission, surgery was performed for her sternum fracture, multiple pelvic bone fractures, and left tibiofibular fracture. Sudden bleeding was observed at the time of placement of a drainage tube for surgical bed drainage during surgery for the pelvic fracture. A left external iliac vein injury was suspected, and the trauma vascular surgeon was contacted. On exploration of the bleeding site, anteroposterior penetration of the left external iliac vein was confirmed. Segmental resection and endto-end anastomosis were performed for the injured vein. The patient recovered without additional vascular complications.