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Chapter 17 - Peripheral Vascular Injury

Published online by Cambridge University Press:  23 August 2019

By
Richard Slama  and
Mike Jackson
Edited by
Alex Koyfman  and
Brit Long
Alex Koyfman
Affiliation:
University of Texas Southwestern Medical Center
Brit Long
Affiliation:
San Antonio Military Medical Center
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Summary

Peripheral vascular injury (PVI) is a major concern in the Emergency Department (ED). According to the CDC, there were 33,594 mortalities related to firearms in 2014.1 There were 803,007 cases of aggravated assault that occurred in 2016. Nearly 24% of these (190,000) were performed with firearms and 16% (120,000) with cutting instruments.2 Inevitably, many of these result in damage to the vasculature, leading to blood loss and presentation to the ED. While some forms of injury are immediately life threatening and require emergent intervention, some present asymptomatically, which can lead to delayed or missed diagnoses. Emergency physicians should be well versed in the diagnosis, management, and disposition of these patients. This chapter will focus on the management of penetrating extremity trauma with vascular injury.

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Chapter
Information
The Emergency Medicine Trauma Handbook , pp. 249 - 259
Publisher: Cambridge University Press
Print publication year: 2019

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References

CDC/National Center for Health Statistics. FastStats - Injuries. CDC Fast Stats. www.cdc.gov/nchs/fastats/injury.htm. 2016. Accessed October 11, 2017.Google Scholar
FBI Uniform Crime Reporting Program. FBI – Aggravated Assault. FBI UCR. https://ucr.fbi.gov/crime-in-the-u.s/2016/crime-in-the-u.s.-2016/topic-pages/aggravated-assault. 2016. Accessed January 15, 2018.Google Scholar
Nessen, SC, Lounsbury, DE, Hetz, SP, eds. War Surgery in Afghanistan and Iraq. Washington: Borden Institute; 2008. https://ke.army.mil/bordeninstitute/published_volumes/war_surgery/Prologue_FINAL.pdf. Accessed October 11, 2017.Google Scholar
Lenhart, M, Lounsbury, DE Nessen, SC, Hetz, SP. Ch 7 Orthopedic trauma: open ulna fracture. In: Nessen SC, Lounsbury DE, Hetz SP, eds. War Surgery in Afghanistan and Iraq. Washington: Borden Institute; 2008, p. 273, fig 1.Google Scholar
Kotwal, RS, Butler, FK, Gross, KR, et al. Management of junctional hemorrhage in tactical combat casualty care: TCCC guidelines? Proposed Change 13-03. J Spec Oper Med. 2013;13(4):85–93.Google Scholar
Lenhart, M, Lounsbury, DE, Nessen, SC, Hetz, SP. Ch 8 Vascular trauma. In: Nessen SC, Lounsbury DE, Hetz SP, eds. War Surgery in Afghanistan and Iraq. Washington: Borden Institute; 2008, p. 326, fig 1.Google Scholar
Cannon, J, Morrison, J, Lauer, C, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock. Jt Theater Trauma Syst Clin Pract Guidel. 2012;(March):1–18.Google Scholar
Lenhart, M, Lounsbury, DE, Nessen, SC, Hetz, SP. Ch 5 Abdominopelvic trauma: indirect effects of wounding. In: Nessen SC, Lounsbury DE, Hetz SP, eds. War Surgery in Afghanistan and Iraq. Washington: Borden Institute; 2008, p. 160, fig 1.Google Scholar
Van Waes, O. Treatment of penetrating trauma of the extremities: ten years’ experience at a Dutch level 1 trauma center. Scand J Trauma Resusc Emerg Med. 2013;21(2):1–6.Google Scholar
O’Brien, PJCM. Stents in tents: Endovascular therapy on the battlefields of the global war on terror. J Surg Radiol. 2011;1(2):Photo found at: Wikimedia Commons contributors, “F.Google Scholar
Balogh, Z, McKinley, BA, Cocanour, CS, et al. Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg. 2003;138(6):633–37.CrossRefGoogle ScholarPubMed
Cap, AP, Pidcoke, HF, Spinella, P, et al. Joint Theater Trauma System Clinical Practice Guideline. Damage Control Resuscitation CPG. https://jts.amedd.army.mil/assets/docs/cpgs/JTS_Clinical_Practice_Guidelines_(CPGs)/Damage_Control_Resuscitation_03_Feb_2017_ID18.pdf. 2017;(June):1–34.Google Scholar
Duke, MD, Guidry, C, Guice, J, et al. Restrictive fluid resuscitation in combination with damage control resuscitation: time for adaptation. J Trauma Acute Care Surg. 2012;73(3):674–78.CrossRefGoogle ScholarPubMed
Duchesne, JC, Barbeau, JM, Islam, TM, et al. Damage control resuscitation: from emergency department to the operating room. Am Surg. 2011;77(2):201–6.Google Scholar
Holcomb, JB, Tilley, BC, Baraniuk, S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313(5):471–82.Google Scholar
Holcomb, JB, del Junco, DJ, Fox, EE, et al. The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg. 2013;148(2):127–36.Google Scholar
Jansen, JO, Thomas, R, Loudon, MA, Brooks, A. Damage control resuscitation for patients with major trauma. BMJ. 2009;338:b1778.CrossRefGoogle ScholarPubMed
Williams-Johnson, JA, McDonald, AH, Strachan, GG, Williams, EW. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2) a randomised, placebo-controlled trial. Lancet. 2010;376(6):23–32.Google Scholar
Afshari, A, Wikkelsø, A, Brok, J, Møller, AM, Wetterslev, J. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion. Cochrane database Syst Rev. 2011;(3):CD007871.CrossRefGoogle Scholar
da Luz, LT, Nascimento, B, Rizoli, S. Thrombelastography (TEG®): practical considerations on its clinical use in trauma resuscitation. Scand J Trauma Resusc Emerg Med. 2013;21:29.CrossRefGoogle ScholarPubMed
Wikkelsø, A, Wetterslev, J, Møller, AM, Afshari, A. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database System Rev. 2016;(8):CD007871.Google Scholar
Nickson, C. Thromboelastogram. LITFL. https://lifeinthefastlane.com/ccc/thromboelastogram-teg/. 2014. Accessed January 1, 2017.Google Scholar
Geiderman, JM, Katz, D. General principles of orthopedic injuries. In: Walls, R, Hockberger, R, Gausche-Hill, M, eds., Rosen’s Emergency Medicine – Concepts and Clinical Practice, 2-Volume Set. Elsevier; 2014, pp. 511–33.e2.Google Scholar
Kragh, JF, Littrel, ML, Jones, JA, et al. Battle casualty survival with emergency tourniquet use to stop limb bleeding. J Emerg Med. 2011;41(6):590–97.Google Scholar
Kragh, JFJ, Dubick, MA, Aden, JK, et al. U.S. Military use of tourniquets from 2001 to 2010. Prehospital Emerg Care. 2015;19(2):184–90.Google Scholar
Beekley, AC, Sebesta, JA, Blackbourne, LH, et al. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma. 2008;64(2 Suppl):S28–37; discussion S37.Google ScholarPubMed
NAEMT. Tactical Combat Casualty Care Guidelines for Medical Personnel. 2015;(June).Google Scholar
Passos, E, Dingley, B, Smith, A, et al. Tourniquet Use for Peripheral Vascular Injuries in the Civilian Setting. Vol 45. Elsevier Ltd; 2014.Google Scholar
Mayo Clinic. The return of tourniquets - For Medical Professionals - Mayo Clinic. www.mayoclinic.org/medical-professionals/clinical-updates/trauma/combat-tested-tourniquets-save-lives-limbs. Accessed March 18, 2018.Google Scholar
Dayan, L, Zinmann, C, Stahl, S, Norman, D. Complications associated with prolonged tourniquet application on the battlefield. Mil Med. 2008;173(1):63–66.CrossRefGoogle ScholarPubMed
Rasmussen, T, Stockinger, Z, Antevil, J, et al. Vascular Injury. Joint Trauma System Clinical Practice Guideline. https://jts.amedd.army.mil/assets/docs/cpgs/JTS_Clinical_Practice_Guidelines_(CPGs)/Vascular_Injury_12_Aug_2016_ID46.pdf. 2016. Accessed March 18, 2018.Google Scholar
Clay, JG, Grayson, JK, Zierold, D. Comparative testing of new hemostatic agents in a swine model of extremity arterial and venous hemorrhage. Mil Med. 2010;175(4):280–84.CrossRefGoogle Scholar
Littlejohn, LF, Devlin, JJ, Kircher, SS, et al. Comparison of Celox-A, Chitoflex, WoundStat, and combat gauze hemostatic agents versus standard gauze dressing in control of hemorrhage in a swine model of penetrating trauma. Acad Emerg Med. 2011;18(4):340–50.CrossRefGoogle Scholar
Ivatury, RR, Anand, R, Ordonez, C. Penetrating extremity trauma. World J Surg. 2015;39(6):1389–96.Google Scholar
Wallin, D, Yaghoubian, A, Rosing, D, et al. Computed tomographic angiography as the primary diagnostic modality in penetrating lower extremity vascular injuries: a level I trauma experience. Ann Vasc Surg. 2011;25(5):620–23.Google Scholar
Patterson, BO, Holt, PJ, Cleanthis, M, et al. Imaging vascular trauma. Br J Surg. 2012;99(4):494–505.CrossRefGoogle ScholarPubMed
Mollberg, NM, Wise, SR, Banipal, S, et al. Color-flow duplex screening for upper extremity proximity injuries: a low-yield strategy for therapeutic intervention. Ann Vasc Surg. 2013;27(5):594–98.CrossRefGoogle ScholarPubMed
DeSouza, IS, Benabbas, R, McKee, S, et al. Accuracy of physical exam, ankle-brachial index, and ultrasonography in the diagnosis of arterial injury in patients with penetrating extremity trauma: a systematic review and meta-analysis. Acad Emerg Med. 2017;8:994–1017.CrossRefGoogle Scholar
Zalavras, CG, Patzakis, MJ, Holtom, PD, Sherman, R. Management of open fractures. Infect Dis Clin North Am. 2005;19(4):915–29.CrossRefGoogle ScholarPubMed
Simpson, BM, Wilson, RH, Grant, RE. Antibiotic therapy in gunshot wound injuries. Clin Orthop Relat Res. 2003;(408):82–85. www.ncbi.nlm.nih.gov/pubmed/12616042. Accessed October 24, 2017.Google Scholar

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