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CME

Vascular Trauma of Extremities - Emergency Management

General Information

General InformationGeneral Information

Description

  • 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

Anatomy

  • 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

Etiology

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

Epidemiology

  • 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

References

References

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 https://www.dynamed.com/topics/dmp~AN~T913036. Registration and login required.

Published by EBSCO Information Services. Copyright © 2020, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.

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