[Vascular injuries of the extremities]

The diagnosis of vascular injuries may be delayed because the symptoms are masked by other injuries or may develop gradually after the first examination took place. If serious ischemic damage is to be avoided, a high degree of diagnostic alertness is necessary, and angiography should be performed whenever vascular injuries are suspected. Most vascular injuries can be repaired by simple techniques: In our experience the most frequently used reconstruction techniques were direct suture of the artery or a longitudinal arteriotomy with thrombendarterectomy and patch plasty. In complicated injuries with much destruction of tissue, the best solution may be an extra-anatomic bypass with a prosthetic graft. Simultaneous venous injuries should be repaired and fasciotomies performed on liberal indications. Pseudoaneurysms and arteriovenous fistulae should be diagnosed and treated early.