• Local and regional effects are determined by mechanism of vessel injury
• Stab wounds, low-velocity (< 2000 ft/s) bullet wounds, iatrogenic injuries, and inadvertent intra-arterial injection of drugs produce less soft-tissue injury and less disruption of collateral circulation
• High-velocity missiles produce more extensive vascular injuries, which involve massive destruction and contamination of surrounding tissues
• Cavitational effect of high-velocity injury causes additional injury and may produce arterial thrombosis due to disrupted intima even when vessel not directly traumatized
• Shotgun blasts produce widespread damage and have higher likelihood of infection
• Motor vehicle accidents are a major cause of blunt arterial injuries
• Most arterial injuries are indirect due to fractures
• Especially likely near joints where vessels are relatively fixed and vulnerable to shear forces
• Contusions or crush injuries may result in complete or partial disruption of arteries
• Peripheral vascular trauma typically occurs in young men between the ages of 20 and 40 years
• Blunt trauma is the principal cause of over 8000 cases of thoracic aortic injuries per year in United States
• About 10-15% of deaths from MVA involve thoracic aortic rupture
• Most aortic ruptures occur in patients aged 20-30 years, with a 9:1 male to female predominance
• 10-20% of patients with acute thoracic disruption survive the initial trauma
-Of these, 30% will die within 6 hours, 40% with 24 hours, 72% in first week, and 90% within 10 weeks without treatment
• Aortic disruption generally occurs at aortic isthmus (between left subclavian and ligamentum arteriosum)
• When pulsatile external hemorrhage is present, diagnosis of arterial injury is obvious
• When blood accumulates in deep tissues the only manifestation may be shock
• Thrombus may form at ends of severed vessels making diagnosis difficult
• Presence of pulses distal to injury DO NOT preclude arterial injury (as many as 20% of injuries will be associated with preserved distal pulses)
• Must be diagnosed promptly to prevent tissue loss
• Must be suspected when patient has 1 or more of the "5 Ps": pain, pallor, paralysis, paresthesias, pulselessness
• Wall is primarily composed of fibrous tissue derived from nearby tissue (not arterial tissue)
• May rupture at any time
• Continue to expand due to absence of elastic fibers
• Spontaneous resolution is unlikely if > 3 cm
• Symptoms gradually appear with compression of surrounding nerves or collateral vessels from rupture or thrombosis
Arteriovenous Fistula (AVF)
• With simultaneous injury of adjacent artery and vein, a fistula may form that allows blood from the artery to enter the vein
• Long-standing AVF can lead to cardiac failure
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