Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XVIII: Vascular Injuries

Debridement and Evaluation of Patency

United States Department of Defense

After gaining control of the injured artery, rapid wound debridement is accomplished in the standard fashion. Excision of devitalized tissue should be complete, including any damaged artery. Debridement of the artery. itself should be as conservative as possible. Only grossly injured artery should be excised. Although microscopic changes have been found in the normal appearing artery adjacent to the obviously traumatized segment, there is no evidence that resection of normal appearing artery on either side of an injured segment is necessary.

Distal arterial patency may be evaluated before repair by careful passage of a balloon tipped catheter. One cannot be certain of distal arterial patency based on the presence of or the rate of back bleeding, as back bleeding simply indicates patency to the level of the first major collateral. Only operative arteriography or reestablishment of distal pulses after repair can be considered proof of distal arterial patency,

The possibility of additional arterial injuries, either close to or at some distance from the recognized injury, should be considered and demonstrated either by intraoperative arteriography, if practical, or by direct exploration. Failure to repair a second arterial injury usually leads to a poor result regardless of the adequacy of repair of the initially recognized injury.

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Operational Medicine 2001

Health Care in Military Settings

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