Vascular injury - Revision history

Danbot: Add verified PubMed references (PMIDs 33883801)

2026-03-22T10:55:49Z

Add verified PubMed references (PMIDs 33883801)

← Older revision		Revision as of 10:55, 22 March 2026
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	==Background==		==Background==
	*Vascular Injury can have a broad spectrum of presentations. Knowing the appropriate assessment of patients presenting with hard and soft signs of vascular injury is paramount to appropriate treatment and disposition.		*Vascular Injury can have a broad spectrum of presentations. Knowing the appropriate assessment of patients presenting with hard and soft signs of vascular injury is paramount to appropriate treatment and disposition.<ref>Bernath MM, Mathew S, Kovoor J. Craniofacial Trauma and Vascular Injury. Semin Intervent Radiol. 2021 Mar;38(1):45-52. PMID 33883801</ref>
	===Types===		===Types===
	*Extremity- Injury to the vasculature of the arms or legs		*Extremity- Injury to the vasculature of the arms or legs

Salamis04: /* References */

2020-07-27T19:45:57Z

References

← Older revision		Revision as of 19:45, 27 July 2020
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	==Background==		==Background==
			*Vascular Injury can have a broad spectrum of presentations. Knowing the appropriate assessment of patients presenting with hard and soft signs of vascular injury is paramount to appropriate treatment and disposition.
	===Types===		===Types===
	*Occlusive		*Extremity- Injury to the vasculature of the arms or legs
	**Transection		*Junctional- Vascular injury where the extremity meets the torso(Hip, axilla, base of neck)
	**Thrombosis		*Non Compressible Truncal Hemorrhage- Anywhere on the torso involving large vasculature.
	**Embolism
	**Reversible spasm		*Within each of these are the following subtypes.
	*Non-occlusive		**Occlusive
	**Laceration		***Transection
	**Intimal flap		***Thrombosis
	**Pseudoaneurysm		***Embolism
	**A/V fistula		**+Reversible spasm
	**[[Compartment syndrome]]		**Non-occlusive
			***Laceration
			***Intimal flap
			***Pseudoaneurysm
			***A/V fistula
			***[[Compartment syndrome]]

	===Occult Upper Extremity Vascular Injury===		===Occult Upper Extremity Vascular Injury===
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	===Soft Signs===		===Soft Signs===
	*Small nonexpanding hematoma		*Small nonexpanding hematoma
			*subjectively decreased pulse
	*Peripheral nerve deficit		*Peripheral nerve deficit
	*History of pulsatile or significant hemorrhage at time of injury		*History of pulsatile or significant hemorrhage at time of injury
	*Unexplained hypotension		*Unexplained hypotension
	*~~Bony injury~~ (fracture, dislocation, penetration) ~~or proximity to penetrating wound~~		*High risk orthopedic injuries (fracture, dislocation, penetration)

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	===Arterial Pressure Index (API)===		===Arterial Pressure Index (API)/Injured Extremity Index (IEI)===
	*Doppler-determined arterial systolic blood pressure in injured limb divided by systolic blood pressure in uninjured limb		*Doppler-determined arterial systolic blood pressure in injured limb divided by systolic blood pressure in uninjured limb
	**<0.9 abnormal		**<0.9 abnormal, > 0.9 is highly sensitive for excluding major vascular injury
			*** NPV of IEI >0.9 is ~96%
	**Allows for serial, objective monitoring		**Allows for serial, objective monitoring
	**Only detects obstructive lesions		**Only detects obstructive lesions
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	**False negative with deep femoral artery injury		**False negative with deep femoral artery injury

	===~~Duplex Doppler~~===		===Imaging Modalities===
	*S 95-100%; Sp 97-100%; Acc 98-100%		*CT Angiography
	*Sens for vessel injury, thrombosis, pseudoaneurysm, intimal flap and A-V fistula		**The Gold standard for excluding vascular Injury
			**Highest sensitivity, specificity
			**Useful for detection of other injuries(Venous, neural, fractures, etc)
			*Dupplex Doppler
			**Can be operator dependent and does NOT definitively exclude arterial Injury
			**S 95-100%; Sp 97-100%; Acc 98-100%
			**Sens for vessel injury, thrombosis, pseudoaneurysm, intimal flap and A-V fistula
			*Point of care ultrasound
			**useful as an adjunct, but there are no randomized trials proving sensitivity.

	===Evaluation Algorithm===		===Evaluation Algorithm===
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	==References==		==References==
	<references/>		<references/>
			*Slama, R., & Jackson, M. (2019). Peripheral Vascular Injury. In A. Koyfman & B. Long (Eds.), The Emergency Medicine Trauma Handbook (pp. 249-259). Cambridge: Cambridge University Press. doi:10.1017/9781108647397.018
	[[Category:Vascular]]		[[Category:Vascular]]
	[[Category:Cardiology]]		[[Category:Cardiology]]
	[[Category:Trauma]]		[[Category:Trauma]]

Davidediger: /* Management */

2018-12-17T15:33:46Z

Management

← Older revision		Revision as of 15:33, 17 December 2018
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	==Management==		==Management==
	*Depends on injury type		*Depends on injury type
	*Consider ~~emergenr~~ vascular surgery consult		*Consider emergent vascular surgery consult

	==Disposition==		==Disposition==

Mholtz at 06:06, 15 November 2018

2018-11-15T06:06:44Z

← Older revision		Revision as of 06:06, 15 November 2018
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	==Background==		==Background==
	===Types===		===Types===
	*~~Complete~~ Occlusive		*Occlusive
	**Transection		**Transection
	**Thrombosis		**Thrombosis
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	**Reversible spasm		**Reversible spasm
	*Non-occlusive		*Non-occlusive
	**~~Lacerations~~		**Laceration
	**Intimal ~~flaps~~		**Intimal flap
	**Pseudoaneurysm		**Pseudoaneurysm
	**A/V fistula		**A/V fistula
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	===Occult Upper Extremity Vascular Injury===		===Occult Upper Extremity Vascular Injury===
	*[[Clavicle fracture]]/1st rib ~~=> subclavian~~ artery		*[[Clavicle fracture]]/1st rib fracture → Subclavian artery
	*Anterior [[shoulder dislocation]] ~~=> axillary~~ artery		*Anterior [[shoulder dislocation]] → Axillary artery
	*[[Proximal humerus fracture]] ~~=> axillary~~ artery		*[[Proximal humerus fracture]] → Axillary artery
	*[[Humeral shaft fracture]] ~~=> brachial~~ artery		*[[Humeral shaft fracture]] → Brachial artery
	*[[Elbow dislocation]] ~~=> brachial~~ artery		*[[Elbow dislocation]] → Brachial artery

	==Clinical Features==		==Clinical Features==
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	===Arterial Pressure Index (API)===		===Arterial Pressure Index (API)===
	*Doppler-determined arterial systolic blood pressure in injured limb divided by systolic blood pressure in uninjured limb		*Doppler-determined arterial systolic blood pressure in injured limb divided by systolic blood pressure in uninjured limb
	**<0.90 abnormal		**<0.9 abnormal
	**Allows for serial, objective monitoring		**Allows for serial, objective monitoring
	**Only detects obstructive lesions		**Only detects obstructive lesions
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	===Evaluation Algorithm===		===Evaluation Algorithm===
	====Hard (>90% risk of arterial injury; 50% require intervention)====		====Hard Signs (>90% risk of arterial injury; 50% require intervention)====
	*Immediate arterial exploration without further investigation		*Immediate arterial exploration without further investigation
	====Soft (30% risk of arterial injury)====		====Soft Signs (30% risk of arterial injury)====
	*API → if < 0.9 obs/admit for 24h, serial API~~, consider~~:		*Perform API → if <0.9 obs/admit for 24h, serial API
			*Consider:
	**Doppler U/S		**Doppler U/S
	**~~CTA~~		**CT angiogram
	**~~Eval~~ of compartment ~~syndrome~~		**Evaluation of compartment pressures

	==Management==		==Management==
	*~~Emergency~~ vascular surgery consult ~~(General surgery if vascular not available)~~		*Depends on injury type
			*Consider emergenr vascular surgery consult

			==Disposition==
			*Dependent on injury type

	==Prognosis==		==Prognosis==
	~~===~~Warm Ischemia Time~~===~~		*Warm Ischemia Time
	*6 hours (10% irreversible damage)		**6 hours (10% irreversible damage)
	*12 hours (90% irreversible damage)		**12 hours (90% irreversible damage)

	==See Also==		==See Also==

Spenceemmett: /* Arterial Pressure Index (API) */

2018-11-13T16:24:14Z

Arterial Pressure Index (API)

← Older revision		Revision as of 16:24, 13 November 2018
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	==Evaluation==		==Evaluation==
	===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 systolic blood pressure in injured limb divided by systolic blood pressure in uninjured limb
	**<0.90 abnormal		**<0.90 abnormal
	**Allows for serial, objective monitoring		**Allows for serial, objective monitoring
	**Only detects obstructive lesions		**Only detects obstructive lesions
	**~~unreliable~~ in proximal injuries, popliteal injuries, shotgun wounds, multiple wounds, shock		**Unreliable in proximal injuries, popliteal injuries, shotgun wounds, multiple wounds, shock
	**~~false~~ negative with deep femoral artery injury		**False negative with deep femoral artery injury

	===Duplex Doppler===		===Duplex Doppler===

Spenceemmett: /* Soft Signs */

2018-11-13T16:22:46Z

Soft Signs

← Older revision		Revision as of 16:22, 13 November 2018
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	*History of pulsatile or significant hemorrhage at time of injury		*History of pulsatile or significant hemorrhage at time of injury
	*Unexplained hypotension		*Unexplained hypotension
	*Bony injury (fracture, dislocation, penetration) or proximity penetrating wound		*Bony injury (fracture, dislocation, penetration) or proximity to penetrating wound

	==Differential Diagnosis==		==Differential Diagnosis==

Spenceemmett: /* Hard signs */

2018-11-13T16:08:31Z

Hard signs

← Older revision		Revision as of 16:08, 13 November 2018
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	**Pain, pallor, paresthesia, paralysis, poikilothermia		**Pain, pallor, paresthesia, paralysis, poikilothermia
	*Audible bruit or palpable thrill at injury site		*Audible bruit or palpable thrill at injury site
	*Active pulsatile ~~hem~~		*Active pulsatile hemorrhage
	*Large expanding hematoma		*Large expanding hematoma
	*Pulsatile hematoma

	===Soft Signs===		===Soft Signs===

Mholtz: Text replacement - "-->" to "→"

2017-02-08T19:56:16Z

Text replacement - "-->" to "→"

← Older revision		Revision as of 19:56, 8 February 2017
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	*Immediate arterial exploration without further investigation		*Immediate arterial exploration without further investigation
	====Soft (30% risk of arterial injury)====		====Soft (30% risk of arterial injury)====
	*API ~~-->~~ if < 0.9 obs/admit for 24h, serial API, consider:		*API → if < 0.9 obs/admit for 24h, serial API, consider:
	**Doppler U/S		**Doppler U/S
	**CTA		**CTA

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-27T01:03:31Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 01:03, 27 July 2016
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	{{Extremity trauma DDX}}		{{Extremity trauma DDX}}

	==~~Diagnosis~~==		==Evaluation==
	===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

Neil.m.young: Text replacement - " ==" to "=="

2016-07-09T20:13:41Z

Text replacement - " ==" to "=="

← Older revision		Revision as of 20:13, 9 July 2016
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	*Pulsatile hematoma		*Pulsatile hematoma

	===Soft Signs ===		===Soft Signs===
	*Small nonexpanding hematoma		*Small nonexpanding hematoma
	*Peripheral nerve deficit		*Peripheral nerve deficit