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Wheeless' Textbook of Orthopaedics
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Arterial Trauma



- See:
        - Artery Menu
        - Arterial Injuries Associated with Fractures
        - Pharmocological Agents in Vascular Surgery:
        - Technique of Microanatomosis:


- Arteriography:


- Types of Injuries:
    - intimal injuries:
    - nonsevered artery:
            - results from blunt force or stretch, may follow passage of missle;
            - results in loss or reduction of flow w/o external signs of bleeding;
            - ischemia is variable, may deveop w/ time & requires serial exam;
            - subintimal dissection may occur lifting flap that occludes lumen;
            - intraluminal hematoma may form that obliterates lumen of artery;
    - venous repair


- Exam:
    - important to recognize that many arteries do not have distal point for palpating pulsations;
            - common and internal carotid, internal iliac, profunda femoris, and peroneal arteries defy examination;
    - w/ arterial trauma to leg or forearm, consider temporarily occluding one distal artery, inorder to assess patency of the other;
            - in the forearm, occlude the ulnar artery inorder to assess patency of radial artery (and vice versa);
            - in the leg, occlude dorsalis pedis artery inorder to assess patency of posterior tibial artery (and vice versa);
    - rapid expansion of a large pulsatile hematoma;
    - presence of systolic or continuous bruit in the region of an injury;
    - marked venous distension of the injured extremity;


- Anatomy:
    - anastomosis of lower limb arteries
    - anastomosis of upper limb arteries


- Management Considerations:
    - arterial injuries associated with fractures
    - reperfusion injury
    - compartment syndrome:
          - fasciotomy of the leg:
          - fasciotomy of the forearm

- Technique of Microanatomosis:




Original Text by Clifford R. Wheeless, III, MD.