Pitfalls in the management of peripheral vascular injuries

Trauma Surgery & Acute Care Open
D V Feliciano

Abstract

Over the past 65+ years, most civilian peripheral vascular injuries have been managed by trauma surgeons with training or experience in vascular repair or ligation. This is appropriate as the in-hospital trauma team is immediately available, and there are often other injuries present in the victim. The pitfall to avoid during evaluation of the patient in the emergency center is a missed diagnosis. In the patient without 'hard' signs of a peripheral vascular injury, a careful history (bleeding), physical examination including measurement of ankle-brachial (ABI) or brachial-brachial index and liberal use of CT arteriography depending on an ABI <0.9 should essentially make the diagnosis if an arterial injury is present. At operation, one pitfall is to limit skin preparation and draping, thereby eliminating the option of removing the greater saphenous vein if needed as a conduit from either the groin or ankle of an uninjured lower extremity. Another pitfall is to make a full longitudinal incision directly over a large pulsatile hematoma. Rather, separate shorter longitudinal incisions should be made to obtain proximal and distal vascular control before entering the hematoma. The failure to recognize patients who should be managed i...Continue Reading

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Citations

Sep 28, 2018·European Heart Journal. Acute Cardiovascular Care·Xavier RosselloUNKNOWN High-Risk Myocardial Infarction Database Initiative
May 7, 2019·Trauma Surgery & Acute Care Open·David V Feliciano
Jul 1, 2020·Annals of Vascular Diseases·Zia Ur RehmanZafar Nazir
Oct 12, 2018·Revista do Colégio Brasileiro de Cirurgiões·Adenauer Marinho de Oliveira Góes JuniorThaiana Cerqueira Ferraz
Jul 7, 2018·Journal of Surgical Case Reports·Rahil DhariaKristoffer Wong
Nov 25, 2020·Stem Cell Reviews and Reports·Xiangyu ShiJiesi Luo
Apr 2, 2021·Trauma Surgery & Acute Care Open·Michael Steven FarrellDeborah M Stein
Aug 4, 2019·International Journal of Surgery Case Reports·Adel ElkbuliDessy Boneva
Sep 3, 2021·Pediatrics International : Official Journal of the Japan Pediatric Society·Mahdi MalekpourLuiz Foernges

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