Validation of Nonoperative Management of Occult Vascular Injuries and Accuracy of Physical Examination Alone in Penetrating Extremity Trauma

Abstract

This is the first long-term follow-up of nonoperative management of clinically occult arterial injuries of the extremities and the use of PE alone in the initial management of PET. The results show these approaches to be safe, effective, and now a proven standard of care.

Difficulties in the Management of Civilian Peripheral Vascular Trauma and their Complications at the University Teaching Hospital of Yaoundé, Cameroon

“…They could further delay an urgent lifesaving treatment procedure. Although we can recognize with some authors that angiography is useful to locate the vascular lesion in case of multiple external injuries [15], however, clinical examination has proved its primacy on diagnostic arteriography in the diagnosis of acute vascular lesions as reported in some studies [16,17].…”

Management of penetrating injuries of the upper extremities

“…[6,8] SNOM is based on clinical examination and additional investigations. Together, they have shown to be a reliable indicator of clinically significant injury, with a sensitivity of 99% and a negative predictive value of 99% in patients with PUET.…”

“…The accuracy of the physical examination to detect vascular injury is very high in patients after penetrating trauma. [6,[8][9][10] Hard signs of a vascular injury (Table 1) mandate emergent surgical exploration, or, when the patient is hemodynamically stable, endovascular treatment could be considered. [7,11] Diagnostic CTA is indicated in hemodynamically stable patients with clinical signs of vascular injury (Table 1).…”

“…Similar to the case with penetrating trauma in other body regions, a selective non-operative management (SNOM) protocol should be used in PUET. [2,8,9] Without signs of vascular impairment in PUET, a conservative observational strategy is likely. [8] The present study was undertaken to assess SNOM in PUET in a tertiary referral trauma center (Groote Schuur Hospital, Cape Town), to which over 800 patients with penetrating trauma of the extremities present each year.…”

Endovascular Therapy And Controversies In The Management Of Vascular Trauma

“…While endovascular treatments have become very attractive, one must be aware of not "over-treating" patients simply because a minimally invasive treatment is available. As pointed out by dennis et al (3), there has been successful conservative management for minor or occult vascular injuries. these injures have resolved with no invasive intervention whatsoever.…”