Extremities--indications and techniques for treatment of extremity vascular injuries

Traumatic vascular injuries involving the extremity are rare and penetrating trauma accounts for the majority of such injuries. The remaining arterial injuries are as a result of either blunt or iatrogenic injuries. The rapid detection, localisation and characterisation of vascular injuries in patients who have a traumatic extremity injury is essential for the effective management and treatment of such injuries. This review will discuss the expanding role of multi-detector computed tomography angiography in diagnosing vascular injuries and its implications on conventional diagnostic angiography. The roles of other non-invasive imaging modalities are reviewed. The presentation and types of vascular injuries in blunt and penetrating injuries are discussed. While surgery remains the gold standard in the management of vascular extremity injuries it has significant morbidity rates. Endovascular techniques are increasingly being used for the treatment of vascular traumatic injuries and various techniques including balloon occlusion, embolisation and stent/stent graft placement are discussed.