Penetrating Vascular Trauma of the Upper and Lower Limbs

Abstract

Patients with penetrating extremity vascular injury and hard clinical signs should undergo immediate surgery. If the arterial injury needs to be localized, on-table arteriogram in the operating room or in a hybrid suite is performed. Computed tomographic angiography can also be used if patient’s condition permits to evaluate extremity vascular injury. A tourniquet can be used as hemorrhage control during early resuscitation and for proximal vascular control during surgery. An intravascular shunt may be inserted in a damage control situation. Definitive arterial and venous repair is performed with standard vascular techniques. There is a role for endovascular techniques for specific and limited arterial injuries after penetrating trauma, but the technique needs further evaluation. This review article focuses on the specific management of penetrating vascular injuries in the upper and lower limbs.