how to diagnose and mange arterial injury

1. Dr Samer regal
Professor of vascular surgery

2. The risk to life and limb remains significant and
the margin for error is very thin. Either delay
in recognition of or failure to adequately
manage vascular injuries remains alarmingly
common in trauma centers.

3. It is common either in war or civil times
.caused by:
blunt (diffused )or penetrating
injury(more focal)
iatrogenic injury(post cardiac catheters)

4. Blunt injury associated with higher amputation
rate due to:
.delayed diagnosis
.associated with significant fracture or
tissue loss
.diffused form of injury
. disrupts smaller vessels that would
normally provide collateral flow

6. Vascular trauma produces a spectrum of
findings from life-threatening hemorrhage
from major vessel laceration to no overtly
detectable findings in minimal injuries.

7. contusion
puncture
laceration
transection (complete or partial)

8. .proximity of the vessels to the bone
.vessels nearly fixed beside joints
(popliteal artery injury in knee dislocation)
.superficial location of the vessels

11. Physical exam
Doppler pressure (Ankle/brachial systolic
pressure index)
Duplex scanning
Arteriogram
Exploration

12. HARD SIGNS OFVASCULAR
INJURY
absent
pulses
bruit or
thrill
active hge
expanding
hematoma
distal
ischemia
SOFT SIGNS OFVASCULAR
INJURY
hematoma
hx of hge
at seen of
accident
unexplained
hypotension
peripheral
nerve
deficit

19. Blood loss (significant in abdomen and chest)
Ischemia-thrombosis
Pseudoaneurysm
Arteriovenous fistula
Compartment syndrome
Tissue necrosis
Amputation
Death

20. .local pressure on the wound
.compression against bony prominence
.don’t use tourniquet unless needed(in hand
and foot)
.don’t apply crushing instrument on a bleeding
artery

21. narrow tourniquet
not control
arterial bleeding
and increase
venous bleeding
10cm wide is
perfect
-
sphygmomanomet
er cuff is the best
deflate every hour

22. Resuscitation
Heparinization
Proximal and distal control of blood vessels
Restoration of circulation
Endovascular management

29. Antithrombotic measures
Avoid hypotension
Distal pulse examination
Limb blood pressure