Infrapopliteal arterial injury: Prompt revascularization affords optimal limb salvage

Lower Extremity Vascular Trauma

“…In blunt trauma, there is a high incidence of limb loss that increases when there is ischemia on presentation. 27 Delayed fasciotomy and the need for fasciotomy revision (extension of the incision or opening of a missed compartment) are associated with increased morbidity and mortality. As such, the authors generally perform prophylactic fourcompartment fasciotomy of the leg utilizing a two-incision approach for those at risk for compartment syndrome: namely, those patients with prolonged ischemia (>4 hours) before revascularization and severe infrageniculate leg injury (i.e., mangled extremity).…”

“…In contrast, blunt trauma to the leg often results in complex tibia and fibula fractures (i.e., Gustillo fractures) which are more prone to injure all of the tibial arteries and result in ischemia. 27 Studies have shown that when tibial vessels are injured by blunt mechanisms, they injuries are almost always associated with a fracture (97%). Blunt mechanisms leading to tibial vascular trauma may also result in open fractures with soft-tissue injuries (59% of cases) and peripheral nerve injuries (53% of cases).…”

“…Less commonly, penetrating trauma leading to tibial vascular injury is associated with fracture (31% of cases), soft-tissue injury (6% of cases), and nerve dysfunction (20% of cases). 27 Like the diagnosis of popliteal artery injury, imaging of the tibial vessels should be performed selectively. In most cases, contrast arteriography and/or exploration of the tibial arteries is reserved for patients with persistent signs of ischemia such as a diminished IEI (<0.90).…”

“…27 The order or priority of injury management in these cases is dictated by the presence or absence of hemorrhage and/or complete ischemia. In cases in which control of bleeding is difficult, exploration of the vascular injury with ligation of the vessel or placement of a temporary vascular shunt may be necessary before fracture reduction and stabilization.…”

Traumatic Disruption of Saphenous Vein Graft Bypassed to the Dorsalis Pedis Artery

“…3) In this case, the saphenous vein graft was completely disrupted and severe forefoot ischemia due to graft occlusion was presented, however, the patient fortunately had no concomitant orthopedic injury or open contaminated wound. Alvarez-Tostado, et al reported a successful treated case of acute critical ischemia secondary to blunt tibial artery injury by endovascular maneuver.…”