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Vascular Injury by OTA
Vascular Injury by OTA
Timothy McHenry, MD
Overview
Epidemiology
Types of Injury
Evaluation
Treatment
Mechanisms of Vascular Injury in
the Extremities
Gunshot wound 54%
Stab wound 15%
Shotgun wound 12%
Blunt trauma 15%
Iatrogenic 3%
Types of Injuries
Active Hemorrhage
Laceration
Partial
transection
Complete
Transection
Types of Injury
Potentially non-occlusive
Contusion with:
Segmental Spasm
Thrombosis
True Aneurysm
Types of Injury
Potentially non-occlusive
Pseudoaneurysm
Arteriovenous Fistula
Intimal Flap
Presentation of Vascular Injury
First priority is
hemorrhage
control followed
by appropriate
diagnostic work-
up
Presentation of Vascular Injury
Dislocations and
displaced or
angulated
fractures:
realigned
immediately if
vascularity is
compromised
Evaluation for Vascular Injury
Physical Examination
Doppler Flowmeter
Duplex Ultrasonography
Arteriogram
Local wound exploration should
not be done in an uncontrolled
setting
Close coordination with a general
or vascular surgeon recommended
Physical Examination
Hard Signs
Absent or diminished distal pulses
Active hemorrhage
Large, expanding or pulsatile hematoma
Bruit or thrill
Distal ischemia (pain, pallor, paralysis,
paresthesias, coolness)
Physical Examination
Soft Signs
Indications:
injuries with hard signs of vascular injury
OR
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