Management of peripheral arterial injury

Abstract

The care of patients with injured peripheral arteries has remained the same in some areas; however, lessons from the battlefield, new imaging technology, the safety of nonoperative management, use of temporary intraluminal shunts, and better recognition of postrepair compartment syndromes have had a significant impact on current management.

Axillary Artery Injury Following Closed Reduction of an Age-Indeterminate Anterior Glenohumeral Dislocation

“…Prompt diagnosis and revascularization is critical, ideally within 2-3 h [10,11]. Clinically, the triad of expanding hematoma, anterior dislocation, and diminished distal pulses has been reported [12,13]. However, given the extensive collateral circulation of the upper extremity, axillary injury has been reported without evidence of decreased pulses [8].…”

Fracture of the shoulder girdle in multiply injured patients - an imperative for a high level of suspicion for associated neurovascular injuries

“…Patients with severe extremity trauma and suspected arterial injury should undergo immediate surgery if hard signs like: pulsatile bleeding, expanding hematoma, palpable thrill and audible bruit are present [5,6]. Literature validated the use of ankle brachial or arterial pulse indexes (ABI and API respectively), which were shown to reliably detect arterial injury to a limb and are easily performed in the Emergency room [5,7]. In hemodynamic stable patients (Case III) a CT scan (including ateriography) can be indicated as part of the primary survey th detect the exact location of the bleeding.…”

Indication and Techniques for Vascular Exploration

“…PTFE and vein grafts must be covered with soft tissue or there is a significant risk of hemorrhage from desiccation of the vein, with subsequent autolysis or breakdown of the anastomosis [ 9 ]. Patients with PTFE placed should be put on ASA of 162-325 mg daily × 3 months postoperatively [ 10 ]. The ASA recommendation is extrapolated from aortosaphenous bypass from CABG data as well as from bypass from peripheral vascular disease.…”