Evaluation and Management of Peripheral
This is a recommended management algorithm from the Western Trauma Association (WTA) addressing the management of peripheral vascular injuries. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, the recommendations herein are based primarily on published observational studies and the expert opinion of WTA members. The algorithm (Fig. 1) and accompanying comments represent a safe and sensible approach that could be followed at most trauma centers. We recognize that there will be patient, personnel, institutional, and situational factors that may warrant or require deviation from the recommended algorithm and encourage institutions to use this guideline to formulate their own local protocols. The algorithm contains letters at decision points, and the corresponding paragraphs in the text elaborate on the thought process and cite the pertinent literature. The annotated algorithm is intended to (a) serve as a quick bedside reference for clinicians, (b) foster more detailed patient care protocols that will allow for prospective data collection and analysis to identify best practices, and (c) generate research projects to answer specific questions concerning decision making in the management of peripheral vascular injuries. The Part I algorithm emphasized evaluation, diagnosis, and need for operation versus a therapeutic procedure performed in an interventional suite, while this Part II algorithm will focus on operative techniques.1
Operative Instrumentation and Ancillary Equipment
Repair of an injured peripheral vessel is performed with the surgeon and assistants wearing loupe magnification and battery-powered head lamps. Standard vascular instruments including shallow and deep retractors, sharp Metzenbaum scissors, DeBakey forceps, Gerald forceps, jeweler’s forceps, fine tipped needle holders, and so on, should be a part of the instrument tray. In addition, vascular adjuncts including vessel loops, Fogarty balloon catheters with stopcocks, intraluminal shunts, unfractionated heparin solution, and a contrast agent for a completion arteriogram should be in the operating room.