Learning objectives
Define several trauma related peripheral vascular injuries,
their types and explain their mechanisms.
Describe and show examples of the diagnostic findings by vascular US,
perform as an initial test and its correlation with angioCT scan.
Signs of suspicion and confirmation.
Present some differential diagnosis.
Background
Vascular injury poses a serious threat to limb and life.
Thus,
diagnosis should be made immediately with minimally invasive methods.
Doppler is a good aid in diagnosis of vascular injury.
Traumatic injuries are one of the most frequent reasons for urgency consultation and are also the leading cause of death in people under 40 years of age.
A high percentage of vascular injuries are secondary to trauma such as,
fractures,
gunshot wounds,
sharps injuries,
traffic accidents,
stabbing,
and blast injury,
also occupational and iatrogenic injuries,...
Findings and procedure details
The 90% of the vascular injuries are found in the lower extremities.
Penetrating neck trauma leads to vascular injuries in 25% of casualties.
Arterial,
venous,
neural,
muscular and bony lesions can coexist.They may have an obvious or hidden hemorrhagic site.
1.
Ethiology: The most frequent mechanisms of vascular injury arepenetrating wounds (bullets,
knives or foreign bodies),crushing,bone fractures andiatrogenic.
This last cause represents 10% of all the cases in some series7.They aresecondary to endovascular procedures such asangioplasty and cardiac catheterisation,
interventionism,
surgeries,
etc.
2.
Clinical presentation:Vascular...
Conclusion
Vascular US is a widely available,
non-invasive,
inexpensive,
fast,
and accuratediagnostic technique that can be used in case of suspicion of trauma related vascular injuries.
Itcan show real time findings,
and can be perform at the bedside of the patient.
It is operator dependant and it has a steep learning curve.
Despite this,
it has high sensitivity and specificity for the detection of peripheral vascular lesions,
which means a high correlation with the current gold standard,
digital angiography and other contrasted imaging methods as angioCT...
Personal information
Contact email:
[email protected]
All the authors work at the Diagnostic ImagingDepartment.
HospitaldetraumaDrFederico Abete.Malvinas Argentinas,BuenosAires.Argentina
References
1.
Montorfano M.A.,
et al.
The FAST D protocol: a simple method to rule out traumatic vascular injuries of the lower extremities.
Crit Ultrasound J2017; 9: 8.
2.
Montorfano M.A.
et al.
Point-of-care ultrasound and Doppler ultrasound evaluation of vascular injuries in penetrating and blunt trauma Crit Ultrasound J2017; 9: 5.
3.Gaitin D.
et al.
Sonographic Evaluation of Vascular Injuries.J Ultrasound Med 2008; 27:95–107
4.
Bynoe RP et al.
Noninvasive diagnosis of vascular trauma by duplex ultrasonography.
J Vasc Surg 1991; 14:346–352.
5.
Singh RR...
