A comprehensive approach to extremity vascular trauma.

A review of our experience with 368 patients with 382 extremity injuries has resulted in a treatment plan resulting in improved patient care and limb survival. A thorough examination of the injured extremity will help diagnose a significant vascular injury in the presence of certain clinical findings, eg, bruit or thrill (100%), signs of acute ischemia (100%), absent pulse (91%), shock (89%), neurologic deficit (78%), and hematoma (55%). Arteriography in proximity injuries has resulted in an abnormal finding in 16% of cases. A total of 165 vascular injuries, including 112 arterial and 53 venous injuries, were repaired using a variety of techniques. In 136 patients undergoing operative intervention, there was no operative mortality and a 1.5% amputation rate.