Management of peripheral arterial injury

Significant changes in the management of patients, with possible or documented injuries to peripheral arteries, have occurred over the last 20 years.

Based on recent military experience, it is likely that the use of tourniquets by civilian emergency medical services systems will increase. Evaluation in the emergency center will continue to rely on a careful physical examination and measurement of an ankle-brachial index (ABI) or arterial pressure index (API). Patients without 'hard signs' of an arterial injury and an API or ABI less than 0.9 should undergo arteriography in the trauma room with a digital subtraction device, in radiology by computed tomography arteriography, which is rapidly replacing conventional arteriography, or surgeon-performed arteriography in the operating room. A temporary intraluminal arterial shunt is indicated in patients with unstable fractures in the extremity or in near-exsanguinated patients needing 'damage control'. A saphenous vein interposition graft is the conduit of choice when segmental resection of an injured artery is necessary. Measurement of postarterial repair compartment pressure is the most definitive way to determine the need for fasciotomy in an injured extremity.

The care of patients with injured peripheral arteries has remained the same in some areas; however, lessons from the battlefield, new imaging technology, the safety of nonoperative management, use of temporary intraluminal shunts, and better recognition of postrepair compartment syndromes have had a significant impact on current management.