The Hip: Preservation, Replacement and Revision

Arterial Trauma

- See:
       - Artery Menu
       - Arterial Injuries Associated with Fractures
       - Pharmocological Agents in Vascular Surgery:
       - Technique of Microanatomosis:

- Arteriography

- Types of Injuries:
    - intimal injuries:
    - nonsevered artery:
           - results from blunt force or stretch, may follow passage of missle;
           - results in loss or reduction of flow w/o external signs of bleeding;
           - ischemia is variable, may deveop w/ time & requires serial exam;
           - subintimal dissection may occur lifting flap that occludes lumen;
           - intraluminal hematoma may form that obliterates lumen of artery;
    - venous repair

- Exam:
    - important to recognize that many arteries do not have distal point for palpating pulsations;
           - common and internal carotid, internal iliac, profunda femoris, and peroneal arteries defy examination;
    - w/ arterial trauma to leg or forearm, consider temporarily occluding one distal artery, inorder to assess patency of the other;
           - in the forearm, occlude the ulnar artery inorder to assess patency of radial artery (and vice versa);
           - in the leg, occlude dorsalis pedis artery inorder to assess patency of posterior tibial artery (and vice versa);
    - rapid expansion of a large pulsatile hematoma;
    - presence of systolic or continuous bruit in the region of an injury;
    - marked venous distension of the injured extremity;

- Anatomy:
    - anastomosis of lower limb arteries
    - anastomosis of upper limb arteries

- Management Considerations:
    - arterial injuries associated with fractures
    - reperfusion injury
    - compartment syndrome:
          - fasciotomy of the leg:
          - fasciotomy of the forearm 

- Technique of Microanatomosis 

- References:  

Ankle–Brachial Index and Peripheral Arterial Disease

Early fasciotomy in patients with extremity vascular injury is associated with decreased risk of adverse limb outcomes: A review of the National Trauma Data Bank

A Proactive Approach to the Coagulopathy of Trauma: The Rationale and Guidelines for Treatment

Surgical Approach to the Pseudoaneurysms of Lower Extremity Arteries Developed After Gunshot Injuries

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, May 30, 2012 3:59 pm