Evaluation and Management of Peripheral
Vascular Injury
Part 1

Risk to the Patient

The primary risk to a patient with a significant peripheral vascular injury is loss of life from exsanguination or the development of multiple organ failure from prehospital nearexsanguination.18  As manual compression or the application of a pressure dressing and elevation of the extremity can almost always control arterial bleeding from an extremity in the field, loss of life should be infrequent in an urban setting. The successful use of tourniquets in Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom by American military forces, however, will almost surely lead to an increased use by civilian emergency medical services in the future.19,20  A secondary risk is loss of the extremity distal to the peripheral arterial injury. This is most commonly due to a delay in diagnosis and/or revascularization, thrombosis of an arterial or venous repair, or the magnitude of associated injuries to soft tissue, bones, or nerves (i.e., Gustilo III C open fracture or close-range shotgun wound). In large series of penetrating wounds to vessels in the extremities in an urban environment, only 2% to 4% of patients undergo immediate amputation and 1.5% to 2% delayed amputation.21 With blunt vascular injuries to the extremities, particularly those associated with open fractures (i.e., Gustilo III C), amputation rates continue to be at least 10% to 20%.16,22