DR. ahmed Abanamy hospital
DOCTOR
Nazih Mohammed Alothman
Vascular Surgeon
management of
peripheral
vascular trauma
Suspicion
of injury
CAUSES
penetrating wounds
Blunt trauma
Invasive procedures
gunshot
Stab wound
Shotgun
Iv drug abuse
Joint displacement
Bone fracture
contusion
Arteriography
Cardiac catheterization
Balloon angioplasty
Hard signs of arterial injury
Obvious arterial occlusion
Rapidly expanding hematoma
Pulse less
Pallor
Paresthesia
Pain
Paralysis
Poikilothermia
Palpated thrill , audible bruit
External arterial bleeding
Immediate
surgery
Soft signs of arterial injury
History of arterial bleeding at the scene
Diminished unilateral distal pulse
Abnormal ankle –brachial pressure index
<(0.9)
Abnormal flow – velocity waveform on
Doppler ultrasound
Small non Pulsatile hematoma
Neurologic deficit
Proximity of penetrating wound or blunt
trauma to major artery
Consider arteriogram
Serial examination
duplex
Role of diagnostic
studies
Reasons for diagnostic studies
Prevent unnecessary operation
Document presence of surgical lesion
Localized surgical lesion to plan operation approach
Arteriography
Can be performed by radiologist
using intra-arterial digital
subtraction angiography or
CT angiograph
Can be performed by surgeon in
emergency room or operating room
Duplex scan
Definition : Real – time B mode(brightness) image and
pulsed – wave Doppler image (flow determination)
Duplex scan should be performed by a competent
vascular technologist or surgeon
Management
Points in peripheral vascular repair
Small vascular clamps or vessel loops
Pass balloon catheter into artery proximal and
distal to repair
Regional heparin into artery proximal and
distal to repair
Completion arteriography
Fasciotomy for compartment syndrome
Options for peripheral vascular repair
1.
2.
3.
4.
5.
6.
7.
Lateral arteriorrhaphy or venorrhaphy
Patch angioplasty
Resection with end- end anastomosis
Resection with interposition graft
Bypass graft
Extra anatomic bypass
ligation
Adjuvant techniques for limb salvage





Intra luminal shunt during orthopedic stabilization
Extra anatomic bypass around associated soft tissue injury
Intra arterial vasodilators (papaverin) to reverse spasm
Intra venous low molecular weight dextran 500MLevery 12 hours
Thrombolytic therapy with intra arterial tissue plasminogen
activator (TPA) by intervention radiologist
Special considerations for venous repair
 Popliteal vein is repaired rather than ligation
 Ligation of femoral or iliac vein if necessary is
usually tolerated if elastic wraps are applied to
extremity , witch is elevated for 7-10 days
Postoperative car
 Monitor distal arterial pulses by portable Doppler
unit
 Continue intravenous antibiotics for 24 hours if
significant contamination of wound or if
interposition graft has been inserted for arterial or
venous repair
 Consider use of antiplatelet agent for 3 months
whenever vein graft or synthetic graft has been
inserted
thanks
DR . nazih Mohammed al -othman