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Vascular Injury / Repair

 

decreased pulses, decreased capillary refill, expanding hematoma

  • ABI = ankle-brachial index = systolic pressure in leg at ankle / systolic pressure in ipsilateral arm
  • IEI = injured extremity index = systolic pressure in injured extremity / systolic pressure in uninvolved arm
  • ABI > 0.90 is normal
  • ABI < 0.90 is abnormal. Highly sensitive and specific for vascualr injury requiring surgical repair.
  • Diagnostic Arteriography: 19 gauge butterfly, 3-way stopcock, 20-30cc syringe, Full strength contrast;  Arterial puncture proximal to injury/repair, Inflow occlusion if possible, X-ray toward end of injection.

Vascular Repair

  • Obtain exposure with longitudinal incision
  • Obtain proximal and distal control
  • Thrombectomoy
  • Proximal and distal heparin injection (1000u Heparin/1 liter saline)
  • Debride vessels to normal wall.
  • Shut or repair (contralateral saphenous graft)
  • Fasciotomy

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