Abstract
The simultaneous management of peripheral vascular injuries in the pursuit of life and limb is very challenging. The decision to amputate or reconstruct an ischemic requires sound judgment that often comes with experience. These patients have significant transfusion requirements and the resuscitation should not be separated from the surgery. Tibial vessels can be ligated when a Doppler signal is obtainable in the distal extremity. Systemic heparin is not necessary; however adequate intimal debridement and liberal flushing with heparinized saline during the repair is essential. A well-covered interposed saphenous vein graft is a durable conduit and favored over prosthetic materials, even if the bypass will occur above the knee. Venous reconstruction should be performed when time permits. Completion arteriography is not usually necessary, but a pulse exam should be confirmed with a continuous wave Doppler signal and ABIs.
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References
McArthur CS, Marin ML. Endovascular therapy for the treatment of arterial trauma. Mt Sinai J Med. 2004;71(1):4–11.
Porter JM, Ivatury RR, Nassoura ZE. Extending the horizons of “damage control” in unstable trauma patients beyond the abdomen and gastrointestinal tract. J Trauma. 1997;42(3):559–61.
Fox CJ, Perkins JG, Kragh Jr JF, Singh NN, Patel B, Ficke JR. Popliteal artery repair in massively transfused military trauma casualties: a pursuit to save life and limb. J Trauma. 2010;69(1 Suppl):S123–34.
Leininger BE, Rasmussen TE, Smith DL, Jenkins DH, Coppola C. Experience with wound VAC and delayed primary closure of contaminated soft tissue injuries in Iraq. J Trauma. 2006;61(1):1207–11.
Rasmussen TE, Dubose JJ, Asensio JA, et al. Tourniquets, vascular shunts, and endovascular technologies: esoteric or essential? A report from the 2011 AAST Military Liaison Panel. J Trauma Acute Care Surg. 2012;73(1):282–5.
Fox CJ, Patel B, Clouse WD. Update on wartime vascular injury. Perspect Vasc Surg Endovasc Ther. 2011;23(1):13–25.
Rich NM, Baugh JH, Hughes CW. Acute arterial injuries in Vietnam: 1,000 cases. J Trauma. 1970;10(5):359–69.
White JM, Stannard A, Burkhardt GE, Eastridge BJ, Blackbourne LH, Rasmussen TE. The epidemiology of vascular injury in the wars in Iraq and Afghanistan. Ann Surg. 2011;253(6):1184–9.
Fox CJ, Gillespie DL, O’Donnell SD, et al. Contemporary management of wartime vascular trauma. J Vasc Surg. 2005;41(4):638–44.
Woodward EB, Clouse WD, Eliason JL, et al. Penetrating femoropopliteal injury during modern warfare: experience of the Balad Vascular Registry. J Vasc Surg. 2008;47(6):1259–64.
White PW, Gillespie DL, Feuerstein IM, et al. Sixty-four slice multidetector computed tomographic angiography in the evaluation of vascular trauma. J Trauma. 2010;68(1):96–102.
Dua A, Patel B, Kragh Jr JF, Holcomb JB, Fox CJ. Long-term follow-up and amputation-free survival in 497 casualties with combat-related vascular injuries and damage-control resuscitation. J Trauma Acute Care Surg. 2012;73(6):1517–24.
Greer LT, Patel B, Via KC, Bowman JN, Weber MA, Fox CJ. Management of secondary hemorrhage from early graft failure in military extremity wounds. J Trauma Acute Care Surg. 2012;73(4):818–24.
Rasmussen TE, Clouse WD, Jenkins DH, Peck MA, Eliason JL, Smith DL. The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury. J Trauma. 2006;61(1):8–12.
Taller J, Kamdar JP, Greene JA, et al. Temporary vascular shunts as initial treatment of proximal extremity vascular injuries during combat operations: the new standard of care at echelon II facilities? J Trauma. 2008;65(1):595–603.
Gifford SM, Aidinian G, Clouse WD, et al. Effect of temporary shunting on extremity vascular injury: an outcome analysis from the Global War on Terror vascular injury initiative. J Vasc Surg. 2009;50(3):549–55.
Starnes BW, Arthurs ZM. Endovascular management of vascular trauma. Perspect Vasc Surg Endovasc Ther. 2006;18(2):114–29.
Reuben BC, Whitten MG, Sarfati M, Kraiss LW. Increasing use of endovascular therapy in acute arterial injuries: analysis of the National Trauma Data Bank. J Vasc Surg. 2007;46(6):1222–6.
Rasmussen TE, Clouse WD, Peck MA, et al. Development and implementation of endovascular capabilities in wartime. J Trauma. 2008;64:1169–76.
Johnson III ON, Fox CJ, White P, et al. Physical exam and occult post-traumatic vascular lesions: implications for the evaluation and management of arterial injuries in modern warfare in the endovascular era. J Cardiovasc Surg (Torino). 2007;48(5):581–6.
Starnes BW, Beekley AC, Sebesta JA, Andersen CA, Rush Jr RM. Extremity vascular injuries on the battlefield: tips for surgeons deploying to war. J Trauma. 2006;60(2):432–42.
Fox CJ, Starnes BW. Vascular surgery on the modern battlefield. Surg Clin North Am. 2007; 87(5):1193–211, xi. Starnes BW, editor. Philadelphia: Elsevier.
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Fox, C.J. (2014). Femoral and Above-Knee Popliteal Injuries. In: Dua, A., Desai, S., Holcomb, J., Burgess, A., Freischlag, J. (eds) Clinical Review of Vascular Trauma. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39100-2_22
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