Vascular Injuries: Indications for Stents, Timing for Vascular and Orthopedic Injuries

  • Luke P. H. LeenenEmail author


Vascular injury accompanying skeletal trauma is relatively rare. However, prompt diagnosis and expeditious repair are the prerequisites for the prevention of amputation. Over the last years, many new techniques for diagnostics, like contrast-enhanced CT and treatment like intraluminal stents, angioembolization have been developed. A close collaboration between the orthopedic and vascular surgeon is critical for the success of the treatment in these difficult cases. Temporary measures like intraluminal shunts and tourniquets have enriched the armamentarium for the treatment of these injuries. When treated early and expeditiously, the general prognosis for these injuries is good.


Vascular trauma Shunt Aortic balloon occlusion Hybrid operating room Tourniquet Limb saving 


  1. 1.
    Andrikopoulos V, Antoniou I, Panoussis P. Arterial injuries associated with lower-extremity fractures. Cardiovasc Surg. 1995;3:15–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Bishara RA, Pasch AR, Douglas DD, Schuler JJ, Lim LT, Flanigan DP. The necessity of mandatory exploration of penetrating zone II neck injuries. Surgery. 1986;100:655–60.PubMedGoogle Scholar
  3. 3.
    Persad IJ, Reddy RS, Saunders MA, Patel J. Gunshot injuries to the extremities: experience of a U.K. trauma centre. Injury. 2005;36:407–11.CrossRefPubMedGoogle Scholar
  4. 4.
    Kragh Jr JF, Walters TJ, Baer DG, et al. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008;64:S38–49.CrossRefPubMedGoogle Scholar
  5. 5.
    Kragh Jr JF, Littrel ML, Jones JA, et al. Battle casualty survival with emergency tourniquet use to stop limb bleeding. J Emerg Med. 2011;41(6):590–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Lynch K, Johansen K. Can Doppler pressure measurement replace “exclusion” arteriography in the diagnosis of occult extremity arterial trauma? Ann Surg. 1991;214:737–41.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Doody O, Given MF, Lyon SM. Extremities–indications and techniques for treatment of extremity vascular injuries. Injury. 2008;39:1295–303.CrossRefPubMedGoogle Scholar
  8. 8.
    Leenen L, Moll FL. Vascular injuries in polytrauma patients. In: Pape H-C, Peitzman AB, Schwab CW, editors. Damage control management in the polytrauma patient. New York: Springer; 2009. p. 315–30.Google Scholar
  9. 9.
    Onal B, Ilgit ET, Kosar S, Akkan K, Gumus T, Akpek S. Endovascular treatment of peripheral vascular lesions with stent-grafts. Diagn Interv Radiol. 2005;11:170–4.PubMedGoogle Scholar
  10. 10.
    Peck MA, Rasmussen TE. Management of blunt peripheral arterial injury. Perspect Vasc Surg Endovasc Ther. 2006;18:159–73.CrossRefPubMedGoogle Scholar
  11. 11.
    Fleiter TR, Mervis S. The role of 3D-CTA in the assessment of peripheral vascular lesions in trauma patients. Eur J Radiol. 2007;64:92–102.CrossRefPubMedGoogle Scholar
  12. 12.
    Morrison JJ, Ross JD, Rasmussen TE, Midwinter MJ, Jansen JO. Resuscitative endovascular balloon occlusion of the aorta: a gap analysis of severely injured UK combat casualties. Shock. 2014;41:388–93.Google Scholar
  13. 13.
    Brenner, Megan L, Moore, et al. A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. J Trauma Acute Care Surg. 2013;75(3):506–11.Google Scholar
  14. 14.
    Al-Salman MM, Al-Khawashki H, Sindigki A, Rabee H, Al-Saif A, Al-Salman FF. Vascular injuries associated with limb fractures. Injury. 1997;28:103–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Huynh TT, Pham M, Griffin LW, et al. Management of distal femoral and popliteal arterial injuries: an update. Am J Surg. 2006;192:773–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Frykberg ER, Vines FS, Alexander RH. The natural history of clinically occult arterial injuries: a prospective evaluation. J Trauma. 1989;29:577–83.CrossRefPubMedGoogle Scholar
  17. 17.
    Cothren CC, Moore EE, Biffl WL, et al. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg. 2004;139:540–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Piffaretti G, Tozzi M, Lomazzi C, et al. Endovascular treatment for traumatic injuries of the peripheral arteries following blunt trauma. Injury. 2007;38:1091–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Cothren CC, Moore EE, Biffl WL, et al. Cervical spine fracture patterns predictive of blunt vertebral artery injury. J Trauma. 2003;55:811–3.CrossRefPubMedGoogle Scholar
  20. 20.
    Biffl WL, Egglin T, Benedetto B, Gibbs F, Cioffi WG. Sixteen-slice computed tomographic angiography is a reliable noninvasive screening test for clinically significant blunt cerebrovascular injuries. J Trauma. 2006;60:745–51.CrossRefPubMedGoogle Scholar
  21. 21.
    Castelli P, Caronno R, Piffaretti G, et al. Endovascular repair of traumatic injuries of the subclavian and axillary arteries. Injury. 2005;36:778–82.CrossRefPubMedGoogle Scholar
  22. 22.
    Scalea TM, Sclafani SJ. Angiographically placed balloons for arterial control: a description of a technique. J Trauma. 1991;31:1671–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Leenen LPH. Pelvic fractures: soft tissue trauma. Eur J Trauma Emerg Surg. 2010;35:117–23.CrossRefGoogle Scholar
  24. 24.
    Segal D, Brenner M, Gorczyca J. Tibial fractures with infrapopliteal arterial injuries. J Orthop Trauma. 1987;1:160–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Brinker MR, Caines MA, Kerstein MD, Elliott MN. Tibial shaft fractures with an associated infrapopliteal arterial injury: a survey of vascular surgeons opinions on the need for vascular repair. J Orthop Trauma. 2000;14:194–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Hafez HM, Woolgar J, Robbs JV. Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg. 2001;33:1212–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of TraumaUMC UtrechtUtrechtThe Netherlands

Personalised recommendations