The Diagnosis and Treatment of Arterial Injuries

Repair of arterial injuries has decreased the amputation rate to 15% from 50%, which was prevalent when ligation was practised. Methods of treatment include lateral repair, resection of damaged area with end-to-end anastomosis, and resection and graft, with or without the assistance of partial or complete cardiopulmonary bypass. Lacerations of large arteries (aorta, iliac) may be treated by lateral repair. Lacerations of smaller arteries are best treated by resection and anastomosis, or by resection and graft. True and false aneurysms and arteriovenous fistulas are best treated by resection and restoration of blood flow. "Spasm" in an artery is frequently due to intimal rupture or subintimal hemorrhage, and likewise requires resection and anastomosis in many instances. Clinical examples of each type of injury are presented. Angiography is of great value in establishing the precise abnormality present, its location, the degree of collateral circulation, and the result achieved by surgery.