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Vascular Trauma to the Extremity: Diagnosis and Management

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Critical Limb Ischemia

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Abstract

The management of vascular injury is a common component in trauma care. Prior to the 1950s, the acute management of peripheral vascular injury largely centered on arterial and venous ligation due primarily to high rates of infection and secondary hemorrhage that often followed attempts at complex vascular repairs. Poor outcomes were common with amputation rates being very high. With the advent of improved suture material, blood banking, antibiotics, anticoagulation, and advanced vascular surgery techniques, primary repair of injured vessels became more common, and surgeons began to explore the possibility of arterial reconstruction in the face of limb trauma. Following the Korean and Vietnam wars, continued advances and improved techniques in the treatment of traumatic limb ischemia reduced amputation rates to less than 10–15 %. Due to the advances in body armor and the commonality of improvised explosive devices, the rate of vascular injury in both the Afghanistan and Iraqi Freedom wars has been estimated to be five times the frequency seen in previously reported combat situations. This increase in pathology has led to significant advances in the way surgeons approach vascular trauma, the most notable of which being the introduction of endovascular therapies into the arsenal of treatment techniques. This chapter reviews current management of critical limb ischemia secondary to trauma, including presentation concerns, diagnostic modalities, and treatment strategies.

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Authors and Affiliations

  1. Department of General Surgery, John H. Stroger Hospital of Cook County, Rush University Medical Center, Chicago, IL, 60611, USA

    Julia M. Boll MD

  2. Surgery, Division of Pre-Hospital and Emergency Trauma Services, Department of Trauma and Burn, JSH Cook County Hospital, Rush Medical College, Chicago, IL, USA

    Andrew J. Dennis DO

  3. Department of Trauma and Burn, JSH Cook County Hospital, Chicago, IL, USA

    Elizabeth Gwinn MD

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  1. Julia M. Boll MD
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  2. Andrew J. Dennis DO
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  3. Elizabeth Gwinn MD
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Editors and Affiliations

  1. Loyola University Medical Center, Maywood, Illinois, USA

    Robert S. Dieter

  2. Northwestern Medicine Central DuPage Hospital, Glen Ellyn, Illinois, USA

    Raymond A. Dieter, Jr

  3. The University of Tennessee Medical Center, Knoxville, Tennessee, USA

    Raymond A. Dieter, III

  4. West Virginia University, Charleston, West Virginia, USA

    Aravinda Nanjundappa

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Boll, J.M., Dennis, A.J., Gwinn, E. (2017). Vascular Trauma to the Extremity: Diagnosis and Management. In: Dieter, R., Dieter, Jr, R., Dieter, III, R., Nanjundappa, A. (eds) Critical Limb Ischemia. Springer, Cham. https://doi.org/10.1007/978-3-319-31991-9_21

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