Vascular Injury

Arterial injury

 

Incidence

 

0.05%

 

Types

 

1. Thrombosis

- most common scenario

- tourniquet with atherosclerosis

- indirect damage to vessel

- femoral or popliteal

 

2.  Embolisation

- atherosclerosis again

- blue toes syndrome post operatively

 

3.  Vessel transection

 

Presentation

- acute ischaemia post operatively

- traumatic aneurysm

- AV fistula

 

Management

- on table angiogram

- externally rotate leg 

- medial approach to posterior knee

- detach medial head of gastrocnemius

- direct artery repair / venous patch / venous or synthetic bypass

 

Problems

- 25-50% amputation rate

- deep infection and sepsis

- wound healing issues

 

History

 

Beware

- symptoms arterial insufficiency

- rest pain, intermittent claudication

- bypass surgery to heart or leg

- diabetic patients

 

Examination

 

Trophic skin changes

 

Feel for popliteal aneurysm

 

Feel for pedal pulses

 

Management absent pedal pulses

 

ABI > 0.5

- do without tourniquet

- vascular consult

- may require immediate postoperative surgery

 

ABI < 0.5

- need bypass surgery first

- certainly need pre-op angiogram