Evaluation and Management of Peripheral
Vascular Injury
Part 1

Annotation for Point C

Patients with external bleeding or a rapidly expanding hematoma anywhere in an injured extremity undergo immediate operation. Other patients with presumed occlusion of a major named artery (limb is threatened) or clinical signs of an arteriovenous fistula (thrill/bruit) in the upper extremity, thigh (excluding the profunda femoris artery), or proximal to the anterior tibial artery and tibioperoneal bifurcation in the leg should undergo immediate operation, as well.^13,17 The remaining hemodynamically stable patients with a presumed wall defect or occlusion of a named artery(i.e., doralis pedis pulse is absent, but foot is clearly well perfused) or clinical signs of an arteriovenous fistula in the distal two third of the leg should undergo diagnostic imaging (see “I,” “J,” and “K”) and possible therapeutic embolization versus nonoperative management (see “M”).²⁵