Traumatic peripheral vascular injuries

Abstract

2-4% of vascular injuries need operative reconstruction. In polytraumatized patients the rate is even 10%. Arterial vascular repair should precede venous reconstruction and orthopaedic stabilization due to limb threatening ischemia. Penetration or blunt vascular trauma result either in acute blood loss, ischemia or compartmental compression. Reperfusion syndrome leads to vital threat of patient. Clinical assessment, measurement of limb pressures using a Doppler device and use of duplex ultrasonography are reliable adjuncts in the rapid evaluation. Arteriography is rarely indicated and should be spared for patients with abnormal physical examination. Minimizing ischemia (6-8 h) is an important factor in maximizing limb salvage. Vascular repair include direct anastomosis or lateral suture repair mostly combined with primary shortening of the extremity. In most cases autogenous vein graft is required. Rethrombosis, arteriovenous fistula and pseudoaneurysms are possible complications. Stabilisation of the fracture has priority over vascular reconstruction. The initial steps to success are surgical debridement, adequate bony stabilization mostly by external fixation, revascularisation of vascular injury, immediate fascial decompression and early soft-tissue reconstruction. The best results are obtained when a multidisciplinary approach is used combining expertise in orthopedic surgery, vascular surgery and plastic surgery.

Evaluation, Surgical Management and Outcome of Traumatic Extremity Vascular Injuries: A 5-year Level-1 Trauma Centres Experience

“… 5 ) In the civilian population, blunt trauma as a result of road side accidents is the major cause, but increasing violence is resulting in more penetrating vascular traumas. 7 ) In this study, 65.4% of the patients suffered blunt traumas, with the majority of them resulting from road side accidents. Penetrating traumas were seen in 34.6% cases; however, civilian cases accounted for only 21.4% (n=6) of the cases, whereas the remaining were related to the battlefield.…”

“…Extremity vascular injuries make up only 3% of all traumatic injuries, but they are associated with potentially fearful complications such as limb loss and even death. 5 , 7 ) The incidence of TEVI is even higher (10%) in patients with poly-trauma. 5 ) In the civilian population, blunt trauma as a result of road side accidents is the major cause, but increasing violence is resulting in more penetrating vascular traumas.…”

Arterial Reconstruction after Mangled Extremity: Injury Severity Scoring Systems Are Not Predictive of Limb Salvage

“…Many authors have recommended initial fracture stabilization followed by vascular repair to prevent possible disruption of vascular anastomosis during fracture stabilization. 23,24 Others recommended proceeding with vascular repair or shunting to reestablish blood flow to the distal extremity before fracture stabilization. 9,25 In our series, an experienced orthopedic team was always available, such that ischemic time was not significantly prolonged and did not affect amputation rates.…”

Correction

“…The strategy of treatment options is based on the type of fracture and associated soft tissue damage, the duration of the warm ischaemic period and the overall condition of the patient [2]. In the case of polytrauma patients and in those who are in a critical condition physiologically, limb salvage may be contraindicated, as the priority is to preserve life [3]. In patients who are stable but have a severely injured limb, the decision for limb salvage or amputation primarily depends on the level of soft tissue injury sustained, as well as neurovascular damage impacting the long-term outcomes.…”