Peripheral Vascular Injuries-Peripheral Vascular Injuries

Video Transcription

Video Summary

This presentation provides a comprehensive overview of peripheral vascular injuries, focusing on their recognition, diagnosis, and management. Peripheral vascular injuries, though accounting for only 1-2% of trauma cases, contribute to 20% of trauma-related deaths and often arise from penetrating trauma (70-80%), such as gunshot or stab wounds, or blunt injuries involving fractures and dislocations. Early identification is vital since delays can lead to ischemia within hours, increasing the risk of tissue damage, amputation, and disability.<br /><br />Key signs of vascular injury include active or pulsatile hemorrhage, expanding hematomas, absent or diminished distal pulses, palpable thrills, and ischemic changes like pallor or cold extremities. The “six Ps” (pulselessness, pallor, paresthesia, pain, paralysis, poikilothermia) indicate hard signs requiring urgent intervention. Diagnostic tools include the ankle-brachial index (ABI), computed tomography angiography (CTA), magnetic resonance angiography (MRA), and point-of-care ultrasound; CTA is considered the gold standard in stable patients.<br /><br />Management follows Advanced Trauma Life Support (ATLS) protocols emphasizing rapid assessment, hemorrhage control (via pressure, tourniquets, and TXA administration), infection prevention through antibiotics, and stabilization of associated injuries. Scoring systems like MESS help predict amputation risk but have limitations. Multidisciplinary care involving vascular, orthopedic, and radiology specialists is often required. Vigilance, prompt diagnosis, and intervention are crucial to optimizing outcomes in vascular trauma.

Keywords

Peripheral vascular injuries

Trauma

Penetrating trauma

Blunt trauma

Ischemia

Six Ps

Ankle-brachial index

Computed tomography angiography