Vascular Extremity Trauma

Excerpt

Trauma to the vascular system can be devastating. The first urgent repair of an arterial injury in the literature occurred on June 15, 1759, by Dr. Hallowell who was encouraged by his colleague Dr. Richard Lambert "to repair the vessel without compromising the lumen." The reason for Dr. Lambert to suggest this repair is that he had observed the morbidity and mortality that patients were suffering from arterial ligation. At this time, many of the vascular injuries were pseudoaneurysm, arterial laceration or arterial-venous fistulas secondary to blood-letters. He felt that a simple repair of the artery would have a greater benefit to the patient than ligation.

Vascular trauma can come in three forms: blunt, penetrating, or combination. These injuries can occur in the civilian or military setting. Fortunately, in the civilian setting, it is an uncommon injury that presents to the trauma bay. Estimates are that penetrating injuries to the extremities account for 5% to 15% of traumas. However, overall vascular injuries account for 1% of all traumatic injuries to extremities. The Western Trauma Association (WTA) and Eastern Association for the Surgery of Trauma (EAST) each have recommendations on the workup and management of vascular injuries.