Vascular Exposures in the Upper Extremities

  • Ana Milena Del Valle
  • Juan Carlos Herrera


Owing to technological advances and lessons learned in modern wars, vascular trauma management has undergone multiple changes. Despite this, acute traumatic hemorrhage remains responsible for 90% of military and 40% of civilian deaths, with vascular injuries of the extremities being the most frequent. According to the Western Trauma Association (WTA), peripheral vascular trauma is defined as injury to the axillobrachial axis and its branches in the upper extremity, or trauma of the femoral-popliteal axis and its collaterals in the lower limb. Forty to 75% of these injuries are secondary to penetrating trauma, mainly gunshot, while blunt trauma occurs in approximately 5–25% of cases. In the upper extremity, brachial artery has the highest incidence of injury. When we confront vascular trauma, physical examination will lead us to its management and treatment, which will be informed by the hemodynamic stability of the patient and the presence of hard or soft signs. In the asymptomatic patient, physical examination and the ankle-brachial index (ABI) or ankle-brachial pressure index (ABPI) will allow a triage management. Currently, the gold standard study for vascular injuries is the Computed Tomography Angiography (CTA). The findings of this test will lead to the type of treatment to be performed, from medical management of vasospasm to endovascular and classic techniques of open surgery.


Trauma Brachial Axillary Radial Ulnar Exposure Vascular Artery 

Suggested Reading

  1. Ascher E, Hollier LH, Strandness DE, Towne JB, Calligaro K, Craig KC, et al. Haimovici’s vascular surgery. 5th ed. Malden: Blackwell Publishing; 2004.CrossRefGoogle Scholar
  2. Cioffi WG, Asensio JA, Adams CA, Biffl WL, Connolly MD, Jurkovich GJ, editors. Atlas of trauma/emergency surgical techniques. Philadelphia: Elsevier Saunders; 2014.Google Scholar
  3. DuBose JJ, Savage SA, Fabian TC, Menaker J, Scalea T, Holcomb JB, et al. The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) registry: multicenter data on modern vascular injury diagnosis management, and outcomes. J Trauma Acute Care Surg. 2015;78:215–23.CrossRefGoogle Scholar
  4. Feliciano D, Moore FA, Moore EE, West MA, Davis JW, Cocanour CS, et al. Evaluation and management of peripheral vascular injury. Part 1. Western Trauma Association/critical decisions in trauma. J Trauma. 2011;70:1551–6.CrossRefGoogle Scholar
  5. Feliciano D, Moore EE, West MA, Moore FA, Davis JW, Cocanour CS, et al. Western Trauma Association critical decisions in trauma: evaluation and management of peripheral vascular injury, Part II. J Trauma Acute Care Surg. 2013;75:391–7.CrossRefGoogle Scholar
  6. Giuffre JL, Kabar S, Bishop AT, Spinner RJ, Shin AY. Current concepts of the treatment of adult brachial plexus injuries. J Hand Surg Am. 2010;35(4):678–88.CrossRefGoogle Scholar
  7. Graham JM, Mattox KL, Feliciano DV, DeBakey ME, et al. Vascular injuries of the axilla. Ann Surg. 1982;195:232–8.CrossRefGoogle Scholar
  8. McCrosky BL, Moore EE, Pearce WH, Moore FA, Cota R, Sawyer JD. Traumatic injuries of the brachial artery. Am J Surg. 1988;156:553–5.CrossRefGoogle Scholar
  9. Tan TW, Joglar FL, Hamburg NM, Eberhardt RT, Shaw PM, Rybin D, et al. Limb outcome and mortality in lower and upper extremity arterial injury: a comparison using the National Trauma Data Bank. Vasc Endovasc Surg. 2011;45(7):592–7.CrossRefGoogle Scholar
  10. Valentine RJ, Wind GG. Anatomic exposures in vascular surgery. 3rd ed. Philadelphia: Lippincott, Williams and Wilkins; 2013.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ana Milena Del Valle
    • 1
  • Juan Carlos Herrera
    • 2
  1. 1.Department of Emergency Medicine, Division of Trauma SurgeryHospital de Urgencia Asistencia Publica (HUAP)SantiagoChile
  2. 2.Department of Surgery, Division of Vascular and Endovascular SurgeryHospital Regional TalcaSantiagoChile

Personalised recommendations