Management of Lower Extremity Vascular Injuries: State of the Art

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• 作者：Rishi Rattan ; Keith M. Jones ; Nicholas Namias
• 关键词：Trauma ; Vascular injury ; Lower extremity vascular injury ; Limb salvage ; Fasciotomy ; Endovascular management
• 刊名：Current Surgery Reports
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：3
• 期：11
• 全文大小：428 KB
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• 作者单位：Rishi Rattan (1) (2)
  Keith M. Jones (2) (3)
  Nicholas Namias (1) (2)
  
  1. Division of Trauma and Acute Care Surgery, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, PO Box 016960 (D-40), Miami, FL, 33101, USA
  2. Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
  3. Division of Vascular Surgery, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
  
• 刊物主题：Surgery;
• 出版者：Springer US
• ISSN：2167-4817

文摘

Expeditious evidence-based management of lower extremity vascular injury is essential to reduce morbidity. Advances in management, largely due to military conflicts, continue to improve outcomes and limb salvage. Diagnosis via an accurate physical exam and adjuncts such as arterial pressure index or computed tomography angiography allow for rapid management. Expedited restoration of flow to major vessels, temporary intravascular shunting in the damage control setting or to restore perfusion before fixation of skeletal injuries, and early fasciotomy remain fundamentals of treatment. While endovascular management has increased significantly in highly selected populations, there are no prospective randomized controlled trials on its use in lower extremity vascular injury and it remains an experimental, off-label approach without any long-term outcomes data. Knowledge of various complications, including those requiring early return to the operating room, are critical to ensure satisfactory outcome. Keywords Trauma Vascular injury Lower extremity vascular injury Limb salvage Fasciotomy Endovascular management