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Extremity Vascular Injuries

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Textbook of Emergency General Surgery

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Abstract

Vascular injuries (VIs) to the extremities account for the majority of traumatic VIs in both civilian and military settings and carry high risks of mortality and morbidity.

The current scientific literature, including the recent VI guidelines, is summarized and analyzed in light of the authors’ personal experiences. Epidemiology, modern classifications, pathophysiology, and key aspects of VI diagnosis and treatment are presented.

Blunt VIs are more frequent in a civilian setting, while penetrating injuries prevail in war. The former have a higher amputation rate and give rise to long-term limb disability, while the latter can lead to catastrophic hemorrhage and death.

Hemorrhage and ischemia are the two main life-threatening consequences. The optimal strategy for timely intervention requires extremity and junctional bleeders to be immediately controlled and ischemia to be recognized.

Open vascular exploration and arterial reconstruction remain the gold standard in the treatment of extremity VIs. However, endovascular and hybrid therapies have a potential role. Repeated pulse examinations and compartment pressure monitoring and release are crucial for better outcomes in the early postoperative period.

Vascular damage control (i.e., temporary shunting or arterial ligation) is a well-proven approach to saving a patient’s life and limb in an unstable clinical or tactical scenario.

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Further Reading

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Author information

Authors and Affiliations

  1. Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russian Federation

    Viktor A. Reva

  2. Federal University of Pará (UFPA) and University Center of Pará State (CESUPA), Belém, PA, Brazil

    Adenauer Marinho de Oliveira Góes Junior

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  1. Viktor A. Reva
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  2. Adenauer Marinho de Oliveira Góes Junior
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Editors and Affiliations

  1. General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Pisa, Italy

    Federico Coccolini

  2. General and Emergency Surgery Dept., Bufalini Hospital, Cesena, Italy

    Fausto Catena

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Reva, V.A., Marinho de Oliveira Góes Junior, A. (2023). Extremity Vascular Injuries. In: Coccolini, F., Catena, F. (eds) Textbook of Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-22599-4_108

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  • DOI: https://doi.org/10.1007/978-3-031-22599-4_108

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