American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of peripheral vascular injuries.

Abstract

The peripheral arteries and veins of the extremities are among the most commonly injured vessels in both civilian and military vascular trauma. Blunt causes are more frequent than penetrating except during military conflicts and in certain geographic areas. Physical examination and simple bedside investigations of pulse pressures are key in early identification of these injuries. In stable patients with equivocal physical examinations, computed tomography angiograms have become the mainstay of screening and diagnosis. Immediate open surgical repair remains the first-line therapy in most patients. However, advances in endovascular therapies and more widespread availability of this technology have resulted in an increase in the range of injuries and frequency of utilization of minimally invasive treatments for vascular injuries in stable patients. Prevention of and early detection and treatment of compartment syndrome remain essential in the recovery of patients with significant peripheral vascular injuries. The decision to perform amputation in patients with mangled extremities remains difficult with few clear indicators. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seeks to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of peripheral vascular injuries. LEVEL OF EVIDENCE: Review study, level IV.

• Authors: Leslie Kobayashi, Raul Coimbra, Adenauer M O Goes Jr, Viktor Reva, Jarrett Santorelli, Ernest E Moore, Joseph Galante, Fikri Abu-Zidan, Andrew B Peitzman, Carlos Ordonez, Ronald V Maier, Salomone Di Saverio, Rao Ivatury, Nicola De Angelis, Thomas Scalea, Fausto Catena, Andrew Kirkpatrick, Vladimir Khokha, Neil Parry, Ian Civil, Ari Leppaniemi, Mircea Chirica, Emmanouil Pikoulis, Gustavo P Fraga, Massimo Chiarugi, Dimitrios Damaskos, Enrico Cicuttin, Marco Ceresoli, Belinda De Simone, Felipe Vega-Rivera, Massimo Sartelli, Walt Biffl, Luca Ansaloni, Dieter G Weber, Federico Coccolini
• Journal: The journal of trauma and acute care surgery (J Trauma Acute Care Surg) Vol. 89 Issue 6 Pg. 1183-1196 (12 2020) ISSN: 2163-0763 [Electronic] United States
• PMID: 33230048 (Publication Type: Journal Article, Review)

Topics

• Amputation, Surgical
• Computed Tomography Angiography
• Endovascular Procedures (methods)
• Humans
• Military Medicine
• Minimally Invasive Surgical Procedures
• Physical Examination
• Practice Guidelines as Topic
• Societies, Medical
• United States
• Vascular System Injuries (diagnosis, surgery)
• Wounds, Nonpenetrating (complications)
• Wounds, Penetrating (complications)