Peripheral Vascular Injuries Treatment & Management

  • Author: Niels Rathlev, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jun 17, 2011
 

Prehospital Care

Perform the following for peripheral vascular injuries:

  • Stabilize the extremity in the anatomic position.
  • Control hemorrhage with direct pressure.
  • Apply a tourniquet proximal to the injury if direct pressure is not effective in controlling hemorrhage.
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Emergency Department Care

  • Immediately reduce displaced or angulated fractures if any evidence or suspicion of vascular compromise exists. Promptly reduce dislocations of the elbow and knee to prevent further injury to neurovascular structures.
  • External hemorrhage usually can be controlled with direct pressure, but a blood pressure cuff or tourniquet should be applied proximally to the injury if compression fails or is not possible.
  • Once the patient has been stabilized, identify peripheral vascular injuries and restore normal circulation as rapidly as possible.
  • Do not apply clamps or hemostats to vascular structures, since this may make definitive repair more difficult and damage surrounding tissues.
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Consultations

A vascular surgeon must be consulted whenever a major vascular injury is a concern.

Vascular injury sustained during battlefield combat is often managed via revascularization. Reconstruction methods should be a focus of combat surgery training. Ligation is also an effective intervention.[15]

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Contributor Information and Disclosures
Author

Niels Rathlev, MD, FACEP  Chair, Department of Emergency Medicine, Tufts University School of Medicine and Baystate Medical Center

Niels Rathlev, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David A Peak, MD  Assistant Residency Director of Harvard Affiliated Emergency Medicine Residency, Attending Physician, Massachusetts General Hospital; Consulting Staff, Department of Hyperbaric Medicine, Massachusetts Eye and Ear Infirmary

David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David B Levy, DO, FACEP, FAAEM  Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. White JM, Stannard A, Burkhardt GE, Eastridge BJ, Blackbourne LH, Rasmussen TE. The epidemiology of vascular injury in the wars in iraq and afghanistan. Ann Surg. Jun 2011;253(6):1184-9. [Medline].

  2. Nassoura ZE, Ivatury RR, Simon RJ, et al. A reassessment of Doppler pressure indices in the detection of arterial lesions in proximity penetrating injuries of extremities: a prospective study. Am J Emerg Med. Mar 1996;14(2):151-6. [Medline].

  3. Espinosa GA, Chiu JC, Samett EJ. Clinical assessment and arteriography for patients with penetrating extremity injuries: a review of 500 cases with the Veterans Affairs West Side Medical Center. Mil Med. Jan 1997;162(1):19-23. [Medline].

  4. Gahtan V, Bramson RT, Norman J. The role of emergent arteriography in penetrating limb trauma. Am Surg. Feb 1994;60(2):123-7. [Medline].

  5. Knudson MM, Lewis FR, Atkinson K, Neuhaus A. The role of duplex ultrasound arterial imaging in patients with penetrating extremity trauma. Arch Surg. Sep 1993;128(9):1033-7; discussion 1037-8. [Medline].

  6. Hood DB, Weaver FA, Yellin AE. Changing perspectives in the diagnosis of peripheral vascular trauma. Semin Vasc Surg. Dec 1998;11(4):255-60. [Medline].

  7. Busquets AR, Acosta JA, Colon E, et al. Helical computed tomographic angiography for the diagnosis of traumatic arterial injuries of the extremities. J Trauma. Mar 2004;56(3):625-8. [Medline].

  8. Rieger M, Mallouhi A, Tauscher T, et al. Traumatic arterial injuries of the extremities: initial evaluation with MDCT angiography. AJR Am J Roentgenol. Mar 2006;186(3):656-64. [Medline].

  9. Soto JA, Munera F, Morales C, et al. Focal arterial injuries of the proximal extremities: helical CT arteriography as the initial method of diagnosis. Radiology. Jan 2001;218(1):188-94. [Medline].

  10. Seamon MJ, Smoger D, Torres DM, Pathak AS, Gaughan JP, Santora TA. A prospective validation of a current practice: the detection of extremity vascular injury with CT angiography. J Trauma. Aug 2009;67(2):238-43; discussion 243-4. [Medline]. [Full Text].

  11. Miller-Thomas MM, West OC, Cohen AM. Diagnosing traumatic arterial injury in the extremities with CT angiography: pearls and pitfalls. Radiographics. Oct 2005;25 Suppl 1:S133-42. [Medline].

  12. 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. Jun 2001;33(6):1212-9. [Medline].

  13. Criado E, Marston WA, Ligush J, et al. Endovascular repair of peripheral aneurysms, pseudoaneurysms, and arteriovenous fistulas. Ann Vasc Surg. May 1997;11(3):256-63. [Medline].

  14. Dennis JW, Frykberg ER, Veldenz HC, et al. Validation of nonoperative management of occult vascular injuries and accuracy of physical examination alone in penetrating extremity trauma: 5- to 10-year follow-up. J Trauma. Feb 1998;44(2):243-52; discussion 242-3. [Medline].

  15. Hoffer EK, Sclafani SJ, Herskowitz MM, Scalea TM. Natural history of arterial injuries diagnosed with arteriography. J Vasc Interv Radiol. Jan-Feb 1997;8(1 Pt 1):43-53. [Medline].

 
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