Vascular Exposures in the Upper Extremities

Abstract

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.