Vascular injury: Difference between revisions

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==Types==
==Types==


===Complete Occlusive===
===Complete Occlusive===
 
*Transection
 
*Thrombosis
Transection
*Embolism
 
*Reversible spasm
Thrombosis
 
Embolism
 
Reversible spasm


   
   


===Non-occlusive===
===Non-occlusive===
 
*Lacerations
 
*Intimal flaps
Lacerations
*Pseudoaneurysm
 
*A/V fistula
Intimal flaps
*Compartment syndrome
 
Pseudoaneurysm
 
A/V fistula
 
Compartment syndrome
 
== ==
 


==Warm Ischemia Time==
==Warm Ischemia Time==
*6 hours (10% irreversible damage)
*12 hours (90% irreversible damage)


6 hours (10% irreversible damage)
12 hours (90% irreversible damage)


==Diagnosis==
==Diagnosis==
 
===Hard signs===
 
*Absent distal pulses
===Hard signs- go straight to OR ===
*Signs of distal ischemia
 
**Pain, pallor, paresthesia, paralysis, poikilothermia
 
*Palpable bruit or audible thrill at injury site
1 Absent distal pulses
*Active pulsatile hem
 
*Large expanding hematoma
2 signs of distal ischemia
*Pulsatile hematoma
 
    Pain, pallor, paresthesia, paralysis, poikilothermia
 
3 palpable bruit or audible thrill at injury site
 
4 active pulsatile hem
 
5 large expanding hematoma
 
6 pulsatile hematoma
 
 
===Soft Signs ===
===Soft Signs ===
 
*Small nonexpanding hematoma
 
*Peripheral nerve deficit
1 small nonexpanding hematoma
*Hx of pulsatile or significant hemorrhage at time of injury
 
*Unexplained hypotension
2 periferal nerve deficit
*Bony injury (fx, dislocation, penetration) or proximity penetrating wound
 
3 hx of pulsatile or significant hem at time of injury
 
4 unexplained hypotension
 
5 bony injury (fx, dislocation, penetration) or proximity penetrating wound
 
 
 
== ==
 
 
===Arterial Pressure Index (API)===
===Arterial Pressure Index (API)===
 
*Doppler-determined arterial sys BP in injured limb divided by pressure in uninjured limb
 
**<0.90 abnormal
Doppler-determined arterial systolic pressure in injured limb divided by pressure in uninjured limb
**Allows for serial, objective monitoring
 
**Only detects obstructive lesions
<0.90 abnormal
**unreliable in proximal injuries, popliteal injuries, shotgun wounds, multiple wounds, shock
 
**false negative with deep femoral artery injury
allows for serial, objective monitoring
 
only detects obstructive lesions
 
unreliable in proximal injuries, popliteal injuries, shotgun wounds, multiple wounds, shock
 
false negative with deep femoral artery injury
 


===Duplex Doppler===
===Duplex Doppler===
 
*S 95-100%; Sp 97-100%; Acc 98-100%
 
*Sens for vessel injury, thrombosis, pseudoaneurysm, intimal flap and A-V fistula
S 95-100%; Sp 97-100%; Acc 98-100%
 
sens for vessel injury, thrombosis, pseudoaneurysm, intimal flap and A-V fistula
 


==Treatment==
==Treatment==
===Hard (>90% risk of arterial injury; 50% require intervention)===
===Hard (>90% risk of arterial injury; 50% require intervention)===
 
*Immediate arterial exploration without further investigation
 
Immediate arterial exploration without further investigation
 
 
===Soft (30% risk of arterial injury)===
===Soft (30% risk of arterial injury)===
 
*API --> if < 0.9 obs/admit for 24h, serial API, consider:
 
**Doppler U/S
**CTA
 
**Eval of compartment syndrome
API --> if < 0.9 obs/admit for 24h, serial API, consider:
 
Doppler U/S
 
CTA
 
Eval of compartment syndrome
 


==Source==
==Source==
Birnbaumer, Donaldson
Birnbaumer, Donaldson


[[Category:Trauma]]
[[Category:Trauma]]

Revision as of 15:57, 5 April 2011

Types

Complete Occlusive

  • Transection
  • Thrombosis
  • Embolism
  • Reversible spasm


Non-occlusive

  • Lacerations
  • Intimal flaps
  • Pseudoaneurysm
  • A/V fistula
  • Compartment syndrome

Warm Ischemia Time

  • 6 hours (10% irreversible damage)
  • 12 hours (90% irreversible damage)


Diagnosis

Hard signs

  • Absent distal pulses
  • Signs of distal ischemia
    • Pain, pallor, paresthesia, paralysis, poikilothermia
  • Palpable bruit or audible thrill at injury site
  • Active pulsatile hem
  • Large expanding hematoma
  • Pulsatile hematoma

Soft Signs

  • Small nonexpanding hematoma
  • Peripheral nerve deficit
  • Hx of pulsatile or significant hemorrhage at time of injury
  • Unexplained hypotension
  • Bony injury (fx, dislocation, penetration) or proximity penetrating wound

Arterial Pressure Index (API)

  • Doppler-determined arterial sys BP in injured limb divided by pressure in uninjured limb
    • <0.90 abnormal
    • Allows for serial, objective monitoring
    • Only detects obstructive lesions
    • unreliable in proximal injuries, popliteal injuries, shotgun wounds, multiple wounds, shock
    • false negative with deep femoral artery injury

Duplex Doppler

  • S 95-100%; Sp 97-100%; Acc 98-100%
  • Sens for vessel injury, thrombosis, pseudoaneurysm, intimal flap and A-V fistula

Treatment

Hard (>90% risk of arterial injury; 50% require intervention)

  • Immediate arterial exploration without further investigation

Soft (30% risk of arterial injury)

  • API --> if < 0.9 obs/admit for 24h, serial API, consider:
    • Doppler U/S
    • CTA
    • Eval of compartment syndrome

Source

Birnbaumer, Donaldson

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