Evaluation and Management of Peripheral
Vascular Injury
Part 1

Types of Vascular Injury

The five recognized types of vascular injuries are as follows: (1) intimal injuries (flaps, disruptions, or subintimal/ intramural hematomas); (2) complete wall defects with pseudoaneurysms or hemorrhage; (3) complete transections with hemorrhage or occlusion; (4) arteriovenous fistulas; and (5) spasm.¹⁷ Intimal defects and subintimal hematomas with possible secondary occlusion are most commonly associated with blunt trauma, while wall defects, complete transections, and arteriovenous fistulas usually occur with penetrating trauma. Spasm can occur after either blunt or penetrating trauma to an extremity and is more common in young patients. When there is an injury to the intima or intima/ media and dilatation of an artery occurs, this is a traumatic true aneurysm with no extravasation of blood outside the lumen of the artery. A full-thickness defect in the wall of an artery with extravasation of blood outside the lumen is an acute pulsatile hematoma immediately after injury and a traumatic false aneurysm when the surrounding tissues encapsulate the blood. Traumatic aneurysms after venous injuries are extraordinarily rare, and traumatic wall defects in many veins seem to heal if local tissue pressure prevents significant extravasation of blood.