Table of contents
Lower extremity arterial injury
What's new
Updated 2020 AAST/WSES and 2019 ABC-T guidelines for the diagnosis and management of lower extremity arterial trauma.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of lower extremity arterial injury are prepared by our editorial team based on guidelines from the Pan-European Multidisciplinary Task Force for Advanced Bleeding Care in Trauma (ABC-T 2023), the Society of Interventional Radiology (SIR 2020), the World Society of Emergency Surgery (WSES/AAST 2020), the American College of Radiology (ACR 2019), the...
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Screening and diagnosis
Indications for testing, hard signs of arterial injury: as per EAST 2012 guidelines, Perform surgical exploration to rule out vascular injury in patients with hard signs of arterial injury on physical examination (pulse deficit, pulsatile bleeding, thrill, expanding hematoma).
B
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Indications for testing (no hard signs of arterial injury)
Diagnostic investigations
CTA: as per ACR 2019 guidelines, Obtain CTA with IV contrast for the initial imaging of lower extremity vascular trauma.
B
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Catheter angiography
Doppler monitoring and duplex ultrasound
Medical management
Nonpharmacologic interventions
Therapeutic procedures
Temporary intravascular shunts
As per EAST 2012 guidelines:
Consider using temporary intravascular shunts to restore arterial flow in patients with combined vascular/orthopedic injuries, in order to facilitate limb perfusion during orthopedic stabilization.
C
Consider using temporary intravascular shunts in "damage control" situations, to facilitate limb perfusion when the physiologic status of the patient or operative capabilities prevent definitive repair.
C
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Angioembolization