Evaluation and management of vascular injuries of the extremities

We reviewed our experience with 315 extremity injuries in 306 patients for the possibility of accurately evaluating the presence of a potential vascular injury. Indications for surgical exploration based on the clinical finding of a bruit and/or thrill, ischemia, absent, pulse, shock, hemorrhage, neurologic deficit, hematoma, and proximity resulted in a rate of positive surgical exploration results of between 20% and 100%. Angiography was performed in 65 patients; 24 angiograms showed vascular injury and 41 did not. Angiography for proximity alone revealed 12% abnormal finding. Operative morbidity in the surgically explored group was 2%. We developed an algorithm for the treatment of these patients.