This document summarizes the history and classification of peripheral vascular injuries. It discusses that peripheral vascular injuries most commonly involve the extremities, with 50-60% occurring in the femoral/popliteal region and 30% in the brachial region. The causes are typically penetrating trauma like gunshots or stab wounds (80%) or blunt trauma. Vascular injuries are classified into 5 types ranging from intimal injuries to complete transections. Physical exam signs of vascular injury can include external bleeding, expanding hematoma, pulselessness, pallor, parasthesias, pain, paralysis, or palpable thrills/audible bruits. Arteriography is important for diagnosis, as timeliness is crucial to avoid life-

1. Anne SaputraAnne SaputraA

2. Historic Perspective
Peripheral vascular injuries:
Upper extremity -> axillobrachial and branches
Lower extremity -> femoropopliteal and branches
1759, First repair performed by Hallowell -> site “blood letting”
1912, Alexis Carrel and Charles C -> developed techniques of arterial repair
World war I, reported by George H. Makins
1946 World war II, reported by DeBakey and Simeone
*Noszczyk W, Witkowski M, Weglowski R. The Zamosc period in the work of Romuald Weglowski. Polski Przegl Chir. 1985;57:440-
445

3. Etiology:
Cases peripheral vascular injury (75-80%), Mechanism:
1. Penetrating Trauma :
• Handguns (Low velocity - low kinetic energy) : 50%
• Stab wounds : 30%
• Shotgun : 5%
2. Blunt Trauma : 5% (Fractures, Dislocation, Crush injuries, and traction)
Most common location : EXTREMITIES -> 50-60% femoral/popliteal, and 30% brachial
*Frykberg ER, Schinco MA. Peripheral vascular injury, In: Feliciano DV, Mattox KL, Moore EE, eds. Trauma. 6th ed. New york, NY: McGraw Hill; 2008:941-971

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5. Types of Vascular Trauma
I : Intimal Injury (flaps, disruption, or
subintimal/intramural hematomas)
II : Complete wall defects with pseudo aneurysms or
haemorrhage
III : Complete transection with haemorrhage or occlusion
IV : Arteriovenous fistula
V : Spasm
*Feliciano DV. Evaluation and treatment of vascular injuries.In: Browner BD, Jupiter JB,
Levine AM, Trafton PG, Krettek C, ends. Skeletal Trauma. Basic Science, Management, and
Reconstruction. Philadelphia, PA: Saunders Elsevier; 2009:323-340

7. HARD SIGN:
•External Bleeding
•Rapid expand hematoma
•5P (Pulselessness, Pallor,
Parasthesias, Pain, Paralysis)
•Palpable thrill/Audible bruit
SOFT SIGN:
•History of arterial bleeding
•Proximity of penetrating
wound/blunt injury to artery
•Small Non pulsatile
hematoma
•Neurologic deficit

9. Arteriography

10. Conclusion
•Time is crucial
•Paramount for diagnosis -> High index of suspicious + physical exam
•Consequences : 1. Primary risk -> Life threatening
2. Secondary risk -> Organ threatening

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