Last update:
09-Jul-2004

This review deals with the current diagnosis and treatment of vascular injuries of the extremities. Such injuries are often associated with trauma to other organs, in which case, the resuscitation of the multiple trauma patient is based on the priorities outlined in the ATLS course. Effective treatment of a lower limb vascular injury aids leg salvage and survival of patient. The clinical presentation of the injury may be predominantly hemorrhage and/or ischemia. The duration of ischemia is a critical factor, determining not only leg viability and function, but also the patient’s outcome after revascularization. The outcome is also related to the manifestation of the compartment syndrome, which may threaten leg salvage, and the reperfusion syndrome, which may be life threatening. Timely revascularization must therefore be one of the basic principles of management. Time may be lost in patient transfer or during angiographic examination in a severely ischemic limb and the management of orthopedic injuries first in such a limb could have catastrophic results. The management of hemorrhage in an extremity includes application of elastic bandages, proximally placed pneumatic devices and avoidance of tourniquet use. The indications for angiography, urgent transfer to the operating room and conservative management are described. Patients with hemorrhage (pulsatile external bleeding, pulsatile hematoma) or severe ischemia are transferred urgently to the operating theatre. Angiographic examination, if necessary, is performed in the operating room. Patients with an apparently normal limb, but possible vascular injury (i.e. existence of bruit, decreased capillary refill, non expanding hematoma, hypotension, fracture, soft tissue injury or history of hemorrhage) should undergo an giographic examination. Patients with trauma in proximity to vascular structures, but withour suspicion of vascular injury, are managed initially by a 24 hour clinical observation. This review covers the standard surgical techniques and endovascular procedures. Endovascular surgical techniques have recently been developed to repair certain vascular injuries via embolisation with coils in a small diameter bleeding artery or arteriovenous fistula. Interposition of a stented graft can correct bleeding from a moderate diameter artery, arteriovenous fistula or pseudoaneurysm.

Key words: Peripheral vascular injuries, Vascular trauma.