Vascular injuries in extremities

Vascular injuries of the extremities account for most instances of vascular trauma (ca. 70%), and they entail a risk of amputation about 10-20%. According to the kind of force that has acted, arterial trauma is classified as direct or indirect. The scale of hemorrhage and peripheral ischemia depend...

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Bibliographic Details
Published in:Chirurg 2004-12, Vol.75 (12), p.1229-38; quiz 1239-40
Main Authors: Ruppert, V, Sadeghi-Azandaryani, M, Mutschler, W, Steckmeier, B
Format: Article
Language:ger
Subjects:
Amputation
Angiography, Digital Subtraction
Arteries - injuries
Arteries - pathology
Arteries - surgery
Extremities - blood supply
Hemorrhage - diagnosis
Hemorrhage - surgery
Hemostasis, Surgical
Humans
Ischemia - diagnosis
Ischemia - surgery
Microsurgery
Multiple Trauma - diagnosis
Multiple Trauma - surgery
Sensitivity and Specificity
Tomography, X-Ray Computed
Ultrasonography, Doppler
Wounds, Nonpenetrating - diagnosis
Wounds, Nonpenetrating - surgery
Wounds, Penetrating - diagnostic imaging
Wounds, Penetrating - surgery
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Summary:Vascular injuries of the extremities account for most instances of vascular trauma (ca. 70%), and they entail a risk of amputation about 10-20%. According to the kind of force that has acted, arterial trauma is classified as direct or indirect. The scale of hemorrhage and peripheral ischemia depend on the nature and severity of the arterial lesion. In patients with multiple injuries, routine use of Doppler sonography and duplex sonography can facilitate early diagnosis and treatment of vascular injuries. With great certainty, clinical examination and an AB or WB index of >1.0 can rule out the presence of vascular injury that requires treatment. After excluding further life-threatening injuries, surgery should be performed immediately when there is critical ischemia, squirting hemorrhage, or a rapidly expanding hematoma. Angiography or duplex sonography findings determine the further procedure in vascular injuries that do not require immediate treatment. Occlusion of a reconstructed artery, manifestation of a compartment syndrome, and insufficient anticoagulation are the main factors affecting the risk of amputation.
ISSN:0009-4722
DOI:10.1007/s00104-004-0965-y