This document discusses vascular trauma to the lower limbs, specifically: 1. It provides epidemiological data on lower limb vascular injuries, noting they make up 26% of extremity injuries and are more common in males from penetrating trauma. 2. Outcomes include higher mortality rates for blunt injuries and amputation rates ranging from 7-30% for injuries below the knee. Associated bone fractures occur in 80-100% of blunt injuries. 3. Examination findings and investigations like Doppler, CT angiography are discussed for evaluating the extent of injury. 4. Treatment principles covered include non-operative management for small injuries, endovascular techniques for iliac vessels, and open surgical repair with grafts and

1. Vascular Trauma -
Lower Limb
Department of Vascular Surgery
Dr Junish Singh Bagga
Respected Mentors - Dr Nihar Ranjan Pradhan
Dr Pinjala Ramakrishna

2. Epidemiology and pattern of
injury
• Extremity vascular injury - 1-2%
• PROOVIT registry -
Males - 70.5%
Penetrating trauma - 36.5%
Lower extremity - 26%
DuBose JJ, et al; AAST PROOVIT Study Group. The American Association for the Surgery of Trauma
PROspective Observational Vascular Injury Treatment (PROOVIT) registry: multicenter data on
modern vascular injury diagnosis, management, and outcomes. J Trauma Acute Care Surg. 2015
Feb;78(2):215-22

3. Outcome
• Mortality - more in blunt injury
• Amputation - 7-30% more with infra popliteal injury
Associated tissue injuries -
• Bone # - 80-100% (blunt)
• Venous Injury - 15-35%
• Nerve injury - 10% in lower limb, 40% in upper limb

4. Examination and
Investigation
• Physical exam alone has high
positive predictive value
• Hard signs - should be surgically
explored
• Soft signs - investigation
• Doppler derived pressure index
• Colour doppler has limited role
• CECT Angiogram

5. Mess score

6. Treatment Principles
Non operative Management
• Trauma to distal branches
• May be successful in upto 70 % of cases
• Small, non-flow limiting intimal defects and flaps, small
pseudoanneurysms, AV fistulas

7. Endo-Vascular Therapy
• 30 fold increase in
use of stent grafts in
the last 2 decades
• More frequently used
for blunt trauma - iliac
vessels
• End vascular balloon
occlusion / opening
abdomen for proximal
vessel control

8. Open surgical management
• Mainstay
• Preferably with fluoroscopic assistance
• Reversed saphenous vein grafts
• Vascular control -> Thrombectomy -> repair.
• Anti- coagulation

9. Temporary shunting
• Allow distal perfusion
during fracture
stabilisation
• Arterial shunts
• Damage control
• 12-24 hours

10. Venous repair vs Ligation
• Controversial
• 24-96 hours post operative all repairs had occluded
• This occlusion can be transient and recanalisation at 12
weeks may be as high as 85%
• Repair may reduce limb edema
• VTE
• Patients physiologic condition

11. Recent Case
25 year male
Apollo Hospital, Jubilee Hills
Referred from Nanded
Penetrating injury into the left thigh
1 day ago
Compression dressing, first aid, shifted
to hyderabad
Patient immediately taken up, explored
SFA injury
Successfully repaired and discharged
on 3rd post op day