Vascular injury: Difference between revisions
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**A/V fistula | **A/V fistula | ||
**[[Compartment syndrome]] | **[[Compartment syndrome]] | ||
===Occult UE Vascular injury=== | ===Occult UE Vascular injury=== | ||
*Clavicle | *[[Clavicle fracture]]/1st rib => subclavian artery | ||
* | *Anterior [[shoulder dislocation]] => axillary artery | ||
* | *[[Proximal humerus fracture]] => axillary artery | ||
*Humeral shaft | *[[Humeral shaft fracture]] => brachial artery | ||
*Elbow | *[[Elbow dislocation]] => brachial artery | ||
==Clinical Features== | |||
===Hard signs=== | ===Hard signs=== | ||
*Absent distal pulses | *Absent distal pulses | ||
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*Large expanding hematoma | *Large expanding hematoma | ||
*Pulsatile hematoma | *Pulsatile hematoma | ||
===Soft Signs === | ===Soft Signs === | ||
*Small nonexpanding hematoma | *Small nonexpanding hematoma | ||
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*Unexplained hypotension | *Unexplained hypotension | ||
*Bony injury (fx, dislocation, penetration) or proximity penetrating wound | *Bony injury (fx, dislocation, penetration) or proximity penetrating wound | ||
==Differential Diagnosis== | |||
==Diagnosis== | |||
===Arterial Pressure Index (API)=== | ===Arterial Pressure Index (API)=== | ||
*Doppler-determined arterial sys BP in injured limb divided by pressure in uninjured limb | *Doppler-determined arterial sys BP in injured limb divided by pressure in uninjured limb | ||
| Line 52: | Line 52: | ||
*Sens for vessel injury, thrombosis, pseudoaneurysm, intimal flap and A-V fistula | *Sens for vessel injury, thrombosis, pseudoaneurysm, intimal flap and A-V fistula | ||
== | ==Management== | ||
===Hard (>90% risk of arterial injury; 50% require intervention)=== | ===Hard (>90% risk of arterial injury; 50% require intervention)=== | ||
*Immediate arterial exploration without further investigation | *Immediate arterial exploration without further investigation | ||
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*[[Angiogram Complication]] | *[[Angiogram Complication]] | ||
== | ==References== | ||
[[Category:Cards]] | [[Category:Cards]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Revision as of 17:00, 8 June 2015
Background
Types
- Complete Occlusive
- Transection
- Thrombosis
- Embolism
- Reversible spasm
- Non-occlusive
- Lacerations
- Intimal flaps
- Pseudoaneurysm
- A/V fistula
- Compartment syndrome
Occult UE Vascular injury
- Clavicle fracture/1st rib => subclavian artery
- Anterior shoulder dislocation => axillary artery
- Proximal humerus fracture => axillary artery
- Humeral shaft fracture => brachial artery
- Elbow dislocation => brachial artery
Clinical Features
Hard signs
- Absent distal pulses
- Signs of distal ischemia
- Pain, pallor, paresthesia, paralysis, poikilothermia
- Audible bruit or palpable thrill at injury site
- Active pulsatile hem
- Large expanding hematoma
- Pulsatile hematoma
Soft Signs
- Small nonexpanding hematoma
- Peripheral nerve deficit
- Hx of pulsatile or significant hemorrhage at time of injury
- Unexplained hypotension
- Bony injury (fx, dislocation, penetration) or proximity penetrating wound
Differential Diagnosis
Diagnosis
Arterial Pressure Index (API)
- Doppler-determined arterial sys BP in injured limb divided by pressure in uninjured limb
- <0.90 abnormal
- Allows for serial, objective monitoring
- Only detects obstructive lesions
- unreliable in proximal injuries, popliteal injuries, shotgun wounds, multiple wounds, shock
- false negative with deep femoral artery injury
Duplex Doppler
- S 95-100%; Sp 97-100%; Acc 98-100%
- Sens for vessel injury, thrombosis, pseudoaneurysm, intimal flap and A-V fistula
Management
Hard (>90% risk of arterial injury; 50% require intervention)
- Immediate arterial exploration without further investigation
Soft (30% risk of arterial injury)
- API --> if < 0.9 obs/admit for 24h, serial API, consider:
- Doppler U/S
- CTA
- Eval of compartment syndrome
Prognosis
Warm Ischemia Time
- 6 hours (10% irreversible damage)
- 12 hours (90% irreversible damage)