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Open and Endovascular Treatment of Penetrating Extremity Arterial Injuries
Lessons learned during United States military operations continue to advance the practice of vascular trauma surgery. Evolving resuscitative strategies, surgical management of fractures and soft tissue wounds, and the expanding application of endovascular therapies represent the latest developments in the current management of penetrating extremity arterial injury.
Resuscitation and Surgical Assessment
Optimal management of penetrating extremity injury requires early recognition and treatment of hemorrhagic shock. The goal is to achieve hemostasis, restore normal physiology, and perform a successful vascular reconstruction upon arrival in the intensive care unit (ICU). Blood products should be rapidly transfused within minutes of admission, with an emergency release of four units of type O packed red blood cells (PRBCs), and two units of thawed AB plasma sent on demand from the blood bank. Unstable patients with more than one bleeding body cavity or mangled extremity are considered in extremis, which should trigger a massive transfusion protocol. The operative intervention is planned after an assessment of the anatomic nature of the injury, with appropriate noninvasive and invasive studies.
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