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Vascular trauma in the extremities is challenging to manage. The risk to life and limb is high and the margin for error is very thin. The presentation varies from obvious life-threatening external hemorrhage to limb ischemia in the unconscious patient with multisystem injury. An organized approach with well-planned and implemented practice guidelines converts an error-prone process into one of opportunity for effective treatment (Table 41-1). Planning and preparation are essential to the success of this approach in view of the numerous causes of delayed recognition and lack of timely treatment. The need for an organized approach is made even more compelling by the advent of trauma systems and improved prehospital care with the resulting increase in the number of patients with what were previously fatal vascular injuries arriving at trauma centers still alive, but in immediate danger of death.1,2

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Table 41-1 Potential Errors in the Recognition, Preoperative Preparation, and Operative Management of Extremity Vascular Trauma

This chapter reviews the pathophysiology, clinical presentation, diagnostic workup, management, and outcome of extremity vascular injuries. The educational objectives of this review include the following:


  1. To identify the mechanisms of extremity vessel injury and the resulting clinical manifestations;

  2. To describe an organized approach to rapidly assess injured patients for the presence of extremity vascular injuries;

  3. To present management guidelines and examples of checklists to assist in the decision of which treatment options best apply and how to effectively implement them;

  4. To articulate management guidelines that result in improved clinical outcomes following extremity vascular injuries; ...

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