Penetrating extremity vascular trauma

1st Line Direct compression and elevation.
2nd Line Tourniquet (document time).

Direct signs

CTA is required if shotgun or skeletal injury. Take direct to theatre. If there is no significant delay and physiology permits consider CT angiography on route to theatre.

Indirect signs

Perform CTA.

Asymptomatic nonocclusive arterial injuries may undergo NOM with subsequent repair if indicated.

• Temporary vascular shunts may be used in damage control scenarios.
• Tibial vessels may be ligated if there is documented flow distally.

Embolisation of profunda branches or tibial vessels is acceptable.

Apply fasciotomy liberally when there is an associated injury or there has been prolonged ischaemia.  If not performed place a compartment monitor.