Vascular Exposures in the Lower Extremities

Abstract

Injury is the leading cause of mortality among people aged 15–44 years. Motor vehicle collisions account for the largest number of traumatic deaths. Hemorrhage is present in 15–25% of admissions in the civilian setting. Hemorrhage that is the secondary disruption of arterial or venous structures in the limbs is classified as compressible hemorrhage. This occurs in accessible sites, and for this reason the first therapeutic maneuver is to compress the site of bleeding with pressure dressing or use a tourniquet to slow the flow of blood. The femoral artery is the most frequently injured vessel in the lower extremities (50–60% of cases). Vascular repair is a systematized process with well-defined stages. These stages must follow the classical principles of vascular reconstruction mentioned in the previous chapter. The surgeon must know the different ways of approaching the vascular structures of the extremities, the techniques of definitive vascular repair, and the techniques of temporary repair such as the vascular shunt. When repairing vascular trauma, anatomical knowledge and vascular techniques are essential; however, the surgeon’s craftiness and improvisation are essential to face the unexpected difficulties of this type of trauma.