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Vascular Trauma of Extremities - Emergency Management

General Information

General InformationGeneral Information


  • Any disruption in the vasculature of an extremity secondary to traumatic mechanism
  • Gunshot wounds, due to their high velocity, produce greater injury to vessels than stab wounds
  • Blunt trauma creates a similar risk of injury as gunshot wounds
  • The most significant independent risk factor for amputation is failed revascularization, thus early surgical consultation is critical


  • Major arteries of the upper extremities are (from proximal to distal): subclavian, axillary, brachial, radial, and ulnar
    • Easy places to palpate pulses in the upper extremities are in the antecubital fossa and at the wrist
  • Major arteries of the lower extremities are (from proximal to distal): iliac, femoral, popliteal, peroneal, tibial (anterior and posterior), and fibular
    • Easy places to palpate pulse in the lower extremities are the groin, popliteal fossa, ankle, and foot


  • Crush injury
  • Displaced fracture
  • Dislocation of joint
  • Penetrating injury (gunshot wound, stab wound, or impaled object)
  • Splinted extremity after injury
  • Traumatic amputation


  • Any victim of trauma can be at risk for vascular injury and must be evaluated if the mechanism warrants a high suspicion1,2,3
  • Vascular injuries to the extremities are relatively low (5%) in civilian populations but much more common in warfare conditions1,2,3
  • Patients with diabetes, hypertension, or known peripheral vascular disease are at increased risk due to already compromised blood flow to the extremities1,2,3
  • Increased incidence with vessels in close proximity to bones/joints, superficial vessels1,2,3
  • Blunt vascular injury has been shown to have over a 2-fold higher rate of amputation than penetrating injury1,2,3
  • Most frequently lower extremity injured vessel is the superficial femoral artery (30%-40%)1,2,3



General references used

  1. Mullenix PS, Steele SR, Andersen CA, Starnes BW, Salim A, Martin MJ. Limb salvage and outcomes among patients with traumatic popliteal vascular injury: an analysis of the National Trauma Data Bank. J Vasc Surg. 2006 Jul;44(1):94-100
  2. Pereira BM, Chiara O, Ramponi F, et al. WSES position paper on vascular emergency surgery. World J Emerg Surg. 2015;10:49
  3. Hafez HM, Woolgar J, Robbs JV. Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg. 2001 Jun;33(6):1212-9
  4. Babar S, Amin MU, Kamal A, Rana A. The Role of 320 Slice CT Angiography in Predicting Vascular Trauma. J Coll Physicians Surg Pak. 2016 Jan;26(1):23-6
  5. Kortbeek JB, Al Turki SA, Ali J, et al. Advanced trauma life support, 8th edition, the evidence for change. J Trauma. 2008 Jun;64(6):1638-50
  6. Feliciano D, Mattox K, Moore E. Trauma. 6th ed. New York, NY: McGraw Hill Medical; 2008
  7. Scerbo MH, Holcomb JB, Taub E, et al. The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock. J Trauma Acute Care Surg. 2017 Dec;83(6):1165-1172
  8. Keeley J, Koopmann M, Yan H, et al. Factors Associated with Amputation after Popliteal Vascular Injuries. Ann Vasc Surg. 2016 May;33:83-7
  9. Kim JJ, Alipour H, Yule A, et al. Outcomes after External Iliac and Femoral Vascular Injuries. Ann Vasc Surg. 2016 May;33:88-93
  10. Kirkilas M, Notrica DM, Langlais CS, Muenzer JT, Zoldos J, Graziano K. Outcomes of arterial vascular extremity trauma in pediatric patients. J Pediatr Surg. 2016 Nov;51(11):1885-1890

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How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T913036, Vascular Trauma of Extremities - Emergency Management; [updated 2018 Nov 30, cited place cited date here]. Available from Registration and login required.

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