They focused on femoral and popliteal artery injuries, searching the database for classic hard vs soft signs, and newer ischemic absent or diminished pulses, frank limb ischemia vs hemorrhagic signs overt hemorrhage, expanding hematoma, hypotension. They examined the presentation, pathology, treatment and outcome in patients in the registry.
The authors concluded that the old hard vs soft signs paradigm no longer works, and suggest that using hemorrhage vs ischemia in now more useful. Bottom line: This is a simple, straightforward descriptive study of five years of vascular injury of the proximal lower extremity. About a third of patients with hard signs had preop imaging, and about the same number with soft signs went straight to OR.
What if most of the centers that chose to participate are much more likely to use diagnostic imaging first, or go straight to OR first? And it also showed that the surgeons were more likely to use endovascular techniques if they were able to take the time for preop imaging. Most importantly, it demonstrated that gross outcomes like death, reoperation, and amputation were not increased by the delay needed to obtain that imaging.
I consider this to be a pilot project. And the authors correctly state that the next step is a true prospective study to confirm that this should be the new way of thinking about hard signs in the future. Click here to get details and subscribe! Email address:. Here are some questions for the presenter and authors. Please provide more information on the database records used. Conclusion: Hard signs have limitations in identification and characterization of extremity arterial injuries.
A strategy of using hemorrhagic and ischemic signs of vascular injury is of greater clinical utility. Further prospective study is needed to validate this proposed redefinition of categorization of presentations of extremity arterial injury.
StatPearls [Internet]. Search term. Vascular Extremity Trauma Gavin H. Author Information Authors Gavin H. Affiliations 1 McLaren Macomb. Continuing Education Activity Vascular trauma can come in three forms: blunt, penetrating, or combination. Introduction Trauma to the vascular system can be devastating.
Etiology Peripheral vascular trauma can occur in either the civilian or military setting. History and Physical As with all trauma patients, advanced trauma life support ATLS protocol should be followed as with any patient that presents to the trauma bay. Evaluation Standard trauma labs should be obtained at the time of presentation.
Differential Diagnosis Five different arterial injuries can occur with either blunt or penetrating injuries. Complications A significant complication of penetrating trauma is acute compartment syndrome; this is a surgical emergency as it causes tissue ischemia and eventually necrosis.
Deterrence and Patient Education A few of the causes of penetrating vascular injuries, such as GSW, can be avoided or decreased with increased gun safety.
Pearls and Other Issues An hourglass narrowing will be seen on arteriography when an end-to-end anastomosis performed under tension. Enhancing Healthcare Team Outcomes Control of traumatic peripheral vascular hemorrhage is vital for the survival of an injured victim. Review Questions Access free multiple choice questions on this topic.
Comment on this article. References 1. Evaluation and management of peripheral vascular injury. Part 1. J Trauma. Lebowitz C, Matzon JL. Hand Clin. Five thousand seven hundred sixty cardiovascular injuries in patients. Epidemiologic evolution to Ann Surg.
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