American Association for the Surgery of Trauma–World Society of Emergency Surgery guidelines on diagnosis and management of peripheral vascular injuries

Abstract

The peripheral arteries and veins of the extremities are among the most commonly injured vessels in both civilian and military vascular trauma. Blunt causes are more frequent than penetrating except during military conflicts and in certain geographic areas. Physical examination and simple bedside investigations of pulse pressures are key in early identification of these injuries. In stable patients with equivocal physical examinations, computed tomography angiograms have become the mainstay of screening and diagnosis. Immediate open surgical repair remains the first-line therapy in most patients. However, advances in endovascular therapies and more widespread availability of this technology have resulted in an increase in the range of injuries and frequency of utilization of minimally invasive treatments for vascular injuries in stable patients. Prevention of and early detection and treatment of compartment syndrome remain essential in the recovery of patients with significant peripheral vascular injuries. The decision to perform amputation in patients with mangled extremities remains difficult with few clear indicators. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seeks to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of peripheral vascular injuries. LEVEL OF EVIDENCE Review study, level IV.

Patient Transfer with Kocher Forceps on the Axillary Artery: A Rare Case of Ongoing Iatrogenic Vascular Injury

“…Finally, apart from the above-mentioned plea for moving the concept of oncovascular surgery forward, we strongly recommend pre-planned appropriate patient positioning and preparation for vein graft harvesting as we advocate against the use of synthetic grafts in a potentially contaminated surgical field [ 11 , 12 ]. The latter would apply in all settings of emergency/trauma cases as well as in other potentially contaminated fields in which major vascular reconstructions are required, such as in the context of multi-visceral resections for abdominopelvic tumors.…”

Damage control of peripheral vascular trauma - Don’t be afraid of axillary or popliteal fosses

“…Otherwise, patients who are hemodynamically stable should undergo an ankle-brachial index and Doppler examination in the Trauma Bay. If positive, then a computed tomographic angiography (CT-Angio) to better delineate the injury 15 .…”

“…Los pacientes con estabilidad hemodinámica deben ser evaluados por medio del índice tobillo-brazo y el uso de Doppler en la escena del trauma. Si es positivo, se puede realizar una angiotomografía (Angio TAC) para identificar mejor la lesión 15 .…”

Embolization in Trauma Patients: What Trauma Radiologists Should Know

“…Procedure time according to injured body region and factors associated with a longer procedure time From a time-critical perspective, the shortest hemostasis is desirable in trauma patients. A decreased time to angioembolization has been much debated in the literature 5,16 ; however, prior literature reporting on the procedure time itself is scarce 17,18 . In this study, there was no delay to angiography compared with time to blood transfusion, and the time to angiography was earlier by previous literatures 17,18 .…”

“…However, an endovascular approach, such as embolization, was recently adopted to manage traumatic vascular lesions in a solid organ injuries 1 not requiring a laparotomy, and in pelvic fractures 2 . In addition to embolization in solid organ injuries and pelvic fractures, embolization has recently also been extended to chest 3 , cerebrovascular 4 , and peripheral vascular injuries 5 .…”