Roles of Trauma CT and CTA in Salvaging the Threatened or Mangled Extremity

CTA Imaging of Peripheral Arterial Injuries

“…Limb ischemia is the primary cause of concern in distal extremity injuries with peripheral arterial trauma; whereas proximal transections of the axillo-subclavian or ilio-femoral axis represent a lifethreatening risk of exsanguination due to a greater caliber of the vessels and greater difficulty in compression in these locations [5].…”

“…Vascular trauma can be or cannot be associated with bone fractures, and the absence of bone fractures cannot exclude the presence of vascular damage. Common fractures associated with loss of distal perfusion are those with bone displacement, segmentation, comminution, or floating joint [5]. The most common location is the femur with an associated wedge-shaped or butterfly fragment at a level close to Hunter's canal, fracture dislocations of the knee, fracture dislocations of the ankle.…”

“…These injuries (type IIIB and IIIC) involve at least three of the four major systems: integument, soft tissue, bone, nerves and vessels [38] (Figure 1). Type IIIC fractures are characterized by extensive bone loss, periosteal stripping with devitalized fragments, massive contamination, poor soft-tissue coverage and arterial injuries that require reperfusion [5]. Approximately 40% of Gustavo type III fractures are associated with significant arterial injuries [5,37,39,40].…”

“…Symptoms of lower limb vascular injuries can be described as hard or soft signs. Hard signs include arterial bleeding, loss of pulse, expanding hematoma, bruit or thrill, and signs of ischemia, and indicate the need for immediate surgical intervention [5]. The classic 6P syndromes defined as paresthesia, pulselessness, paralysis, pain, pallor, and poikilothermia can diagnose damage to lower limbs arteries.…”

“…Vascular trauma accounts for 3% of all traumatic injuries [1][2][3]. Extremities vascular injuries can occur isolated or in association in major trauma with other organ injuries and they account for 1-2% of patients admitted to emergency room (ER) and account for approximately 50% of all arterial injuries [4][5][6], with a prevalence of lower extremities injuries over the upper extremities in adult population [7]. Traumatic vascular injury is characterized by damage to arteries and/or veins.…”