Peripheral Vasculature

  • David V. Feliciano


A high school cheerleader sustains a right supracondylar fracture (radiographic confirmation) after tripping and falling on her outstretched arm. There is evidence of a slight neurologic deficit and vascular insufficiency with diminished distal pulses.The patient has no other injuries and is hemodynamically stable. Which of the following is the most appropriate definitive management approach for the injury?
  1. (A)

    Immobilization of the elbow flexed to 90°

  2. (B)

    Immobilization of the elbow flexed at 45°

  3. (C)

    Traction of the forearm, with countertraction proximally

  4. (C)

    Open exploration and reduction

  5. (E)

    Traction applied to the hyperextended elbow



Brachial Artery Compartment Syndrome Arterial Injury Common Femoral Artery External Iliac Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Allen EV. Thromboangiitis obliterans: methods of diagnosis of chronic occlusive arterial lesions distal to the wrist with illustrative cases. Am J Medical Sci 1929; 1–78:234–244.Google Scholar
  2. 2.
    Ejrup B, Fischer B, Wright IS. Clinical evaluation of blood flow to the hand: the false-positive Allen test. Circulation 1966; 33:778–780.PubMedGoogle Scholar
  3. 3.
    Gardner RM, Schwartz R, Wong HC, et al. Percutaneous indwelling radial-artery catheters for monitoring cardiovascular function. Prospective study of the risk of thrombosis and infection. N Engl J Med 1974; 290:1227–1231.PubMedGoogle Scholar
  4. 4.
    Bedford RF. Long-term radial artery cannulation: effects on subsequent vessel function. Crit Care Med 1978; 6:64–67.CrossRefPubMedGoogle Scholar
  5. 5.
    Johnson FE, Sumner DS, Strandness DE Jr. Extremity necrosis caused by indwelling arterial catheters. Am J Surg 1976; 131:375–379.CrossRefPubMedGoogle Scholar
  6. 6.
    Comerota AJ, Malone MD. Simplified approach to thrombolytic therapy of arterial and graft occlusion. In Yao JST, Pearce WH, eds. Practical Vascular Surgery. Stamford, CT: Appleton & Lange, 1999: 321–334.Google Scholar
  7. 7.
    Mattox KL, Feliciano DV, Burch J, et al. Five thousand seven hundred sixty cardiovascular injuries in 4459 patients. Epidemiologic evolution 1958 to 1987. Ann Surg 1989; 209:698–707.CrossRefPubMedGoogle Scholar
  8. 8.
    Frykberg ER, Schinco MA. Peripheral vascular injury. In Moore EE, Feliciano DV, Mattox KL, eds. Trauma, 5th ed. New York: McGraw-Hill, 2004: 969–1003.Google Scholar
  9. 9.
    DeBakey ME, Simeone FA. Battle injuries of the arteries in World War II. An analysis of 2,471 cases. Ann Surg 1946; 123:534–579.CrossRefPubMedGoogle Scholar
  10. 10.
    O’Gorman RB, Feliciano DV. Arteriography performed in the emergency center. Am J Surg 1986; 152:323–325.CrossRefPubMedGoogle Scholar
  11. 11.
    Frykberg ER, Vines FS, Alexander RH. The natural history of clinically occult arterial injuries: a prospective evaluation. J Trauma 1989; 29:577–583.PubMedCrossRefGoogle Scholar
  12. 12.
    Stain SC, Yellin AE, Weaver FA, et al. Selective management of nonocclusive arterial injuries. Arch Surg 1989; 124:1136–1141.PubMedGoogle Scholar
  13. 13.
    Wind GG, Valentine RJ. Axillary artery. In Wind GG, Valentine RJ, eds. Anatomic Exposures in Vascular Surgery. Baltimore: William & Wilkins, 1991: 138–157.Google Scholar
  14. 14.
    Graham JM, Mattox KL, Feliciano DV, et al. Vascular injuries of the axilla. Ann Surg 1982; 195:232–238.CrossRefPubMedGoogle Scholar
  15. 15.
    Feliciano DV. Managing peripheral vascular trauma. Infect Surg 1986; 5:659–669, 682.Google Scholar
  16. 16.
    Carrell A. The surgery of blood vessels. Johns Hopkins Hosp Bull 1907; 18:18–28.Google Scholar
  17. 17.
    The Dutch Bypass Oral Anticoagulants or Aspirin Study Group. Efficacy of oral anticoagulants compared with aspirin after infrainguinal bypass surgery. The Dutch Bypass Oral Anticoagulants or Aspirin (BOA) Study: a randomized trial. Lancet 2000; 355:346–351.CrossRefPubMedGoogle Scholar
  18. 18.
    Feliciano DV. Heroic procedures in vascular injury management. The role of extra-anatomic bypasses. Surg Clin North Am 2002; 82:115–124.CrossRefPubMedGoogle Scholar
  19. 19.
    Feliciano DV. Evaluation and treatment of vascular injuries. In Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. Philadelphia: W.B. Saunders, 2003: 250–267.Google Scholar
  20. 20.
    Feliciano DV, Moore EE, Mattox KL. Trauma damage control. In Moore EE, Feliciano DV, Mattox KL, eds. Trauma, 5th ed. New York: McGraw-Hill, 2004: 877–900.Google Scholar
  21. 21.
    Sharma PVP, Shah PM, Vinzons AT, et al. Meticulously restored lumina of injured veins remain patent. Surgery 1992; 112:928–932.PubMedGoogle Scholar
  22. 22.
    Parry NG, Feliciano DV, Burke RM, et al. Management and short-term patency of lower extremity venous injuries with various repairs. Am J Surg 2003; 186:631–635.CrossRefPubMedGoogle Scholar
  23. 23.
    Matsen FA III. Compartmental Syndromes. New York: Grune & Stratton, 1980.Google Scholar
  24. 24.
    Amendola A, Twaddle BC. Compartment syndromes. In Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma:. Basic Science, Management, and Reconstruction. Philadelphia: W.B. Saunders, 2003: 268–292.Google Scholar
  25. 25.
    Feliciano DV, Cruse PA, Spjut-Patrinely V, et al. Fasciotomy after trauma to the extremities. Am J Surg 1988; 156:533–536.CrossRefPubMedGoogle Scholar
  26. 26.
    Mubarak SJ, Hargens AR. Compartment syndromes and Volkmann’s contracture. Philadelphia: W.B. Saunders, 1981:117.Google Scholar
  27. 27.
    Whitesides TE Jr, Heckman MM. Acute compartment syndrome: update on diagnosis and treatment. J Am Acad Orthop Surg 1996; 4:209–218.PubMedGoogle Scholar
  28. 28.
    McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br 1996; 78:99–104.PubMedGoogle Scholar
  29. 29.
    Feliciano DV. Management of peripheral vascular trauma (Poster). American College of Surgeons Committee on Trauma/Subcommittee on Publications. Chicago: American College of Surgeons, 2002.Google Scholar
  30. 30.
    Skillman JJ, Kim D, Baim DS. Vascular complications of percutaneous femoral cardiac interventions. Incidence and operative repair. Arch Surg 1988; 123:1207–1212.PubMedGoogle Scholar
  31. 31.
    Cutler BS, Okike ON, Vander Salm TJ. Surgical versus percutaneous removal of the intra-aortic balloon. J Thorac Cardiovasc Surg 1983; 86:907–911.PubMedGoogle Scholar
  32. 32.
    Franco CD, Goldsmith J, Ohki T, et al. Iatrogenic vascular injury. In Hobson RW II, Wilson SE, Veith FJ, eds. Vascular Surgery: Principles and Practice, 3rd ed, revised and expanded. New York: Marcel Dekker, 2004: 1098.Google Scholar
  33. 33.
    Franco CD, Goldsmith J, Veith FJ, et al. Management of arterial injury produced by percutaneous femoral procedures. Surgery 1993; 113:419–425.PubMedGoogle Scholar
  34. 34.
    Hajarizadeh H, LaRosa CR, Cardullo P, et al. Ultrasoundguided compression of iatrogenic femoral pseudoaneurysm. Failure, recurrence, and long-term results. J Vasc Surg 1995; 22:425–433.CrossRefPubMedGoogle Scholar
  35. 35.
    Mills JL, Porter JM. Basic data related to clinical decisionmaking in acute limb ischemia. Ann Vasc Surg 1991; 5:96–98.CrossRefPubMedGoogle Scholar
  36. 36.
    Sharp LS, Rozycki GS, Feliciano DV. Rhabdomyolysis and secondary renal failure in critically ill surgical patients. Am J Surg 2004; 188:801–806.CrossRefPubMedGoogle Scholar
  37. 37.
    Blaisdell FW, Steele M, Allen RE. Management of acute lower extremity arterial ischemia due to embolism and thrombosis. Surgery 1978; 84:822–831.PubMedGoogle Scholar
  38. 38.
    Short D, Vaughn GD III, Jachimczyk J, et al. The anatomic basis for the occasional failure of transfemoral balloon catheter thromboembolectomy. Ann Surg 1979;190:555–556.CrossRefPubMedGoogle Scholar
  39. 39.
    Wilson SE, Van Wagenen P, Passaro E Jr. Arterial infection. Curr Probl Surg 1978; 15:1–89.CrossRefPubMedGoogle Scholar
  40. 40.
    Strinden WD, Dibbell DG Sr, Turnipseed WD, et al. Coverage of acute vascular injuries of the axilla and groin with transposition muscle flaps: case reports. J Trauma 1989; 29:512–516.CrossRefPubMedGoogle Scholar
  41. 41.
    Ting AC, Cheng SW. Femoral pseudoaneurysms in drug addicts. World J Surg 1997; 21:783–787.CrossRefPubMedGoogle Scholar
  42. 42.
    DePalma RG, Hubay CA. Arterial bypass via the obturator foramen. An alternative in complicated vascular problems. Am J Surg 1968; 115:323–328.CrossRefPubMedGoogle Scholar
  43. 43.
    Fromm SH, Lucas CE. Obturator bypass for mycotic aneurysm in the drug addict. Arch Surg 1970; 100:82–83.PubMedGoogle Scholar
  44. 44.
    Valentine RJ, Clagett GP. Aortic graft infections: replacement with autogenous vein. Cardiovasc Surg 2001; 9:419–425.CrossRefPubMedGoogle Scholar
  45. 45.
    Wind GG, Valentine RJ. Axillary artery. In Wind GG, Valentine RJ, eds. Anatomic Exposures in Vascular Surgery. Baltimore: William & Wilkins, 1991: 384–388.Google Scholar
  46. 46.
    Feliciano DV, Herskowitz K, O’Gorman RB, et al. Management of vascular injuries in the lower extremities. J Trauma 1988; 28:319–328.CrossRefPubMedGoogle Scholar
  47. 47.
    Bermudez KM, Knudson MM, Nelken NA, et al. Long-term results of lower-extremity venous injuries. Arch Surg 1997; 132:963–968.PubMedGoogle Scholar
  48. 48.
    Yelon JA, Scalea TM. Venous injuries of the lower extremities and pelvis: repair versus ligation. J Trauma 1992; 33:532–536.CrossRefPubMedGoogle Scholar
  49. 49.
    Timberlake GA, O’Connell RC, Kerstein MD. Venous injury: to repair or ligate—the dilemma. J Vasc Surg 1986; 4:553–558.CrossRefPubMedGoogle Scholar
  50. 50.
    Mullins RJ, Lucas CE, Ledgerwood AM. The natural history following venous ligation for civilian injuries. J Trauma 1980; 20:737–743.CrossRefPubMedGoogle Scholar
  51. 51.
    Rich NM, Hobson RW, Collins GJ Jr, et al. The effect of acute popliteal venous interruption. Ann Surg 1976; 183:365–368.CrossRefPubMedGoogle Scholar
  52. 52.
    Feliciano DV, Mattox KL, Graham JM, et al. Five-year experience with PTFE grafts in vascular wounds. J Trauma 1985; 25:71–82.CrossRefPubMedGoogle Scholar
  53. 53.
    Pappas PJ, Haser PB, Teehan EP, et al. Outcome of complex venous reconstructions in patients with trauma. J Vasc Surg 1997; 25:398–404.CrossRefPubMedGoogle Scholar
  54. 54.
    Zamir G, Berlatzky Y, Rivkind A, et al. Results of reconstruction in major pelvic and extremity venous injuries. J Vasc Surg 1998; 28:901–908.CrossRefPubMedGoogle Scholar
  55. 55.
    Tremblay LN, Feliciano DV, Rozycki GS. Secondary extremity compartment syndrome. J Trauma 2002; 53:833–837.CrossRefPubMedGoogle Scholar
  56. 56.
    Amendola A, Twaddle BC. Compartment syndromes. In Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma: Basic Science, Management and Reconstruction. Philadelphia: W.B. Saunders, 2003: 268–292.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • David V. Feliciano
    • 1
  1. 1.Department of Surgery, Emory University School of MedicineGrady Memorial HospitalAtlantaUSA

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