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

Diagnosis

United States Department of Defense

Injuries to blood vessels consist of several types. Among these are lacerations, transections, avulsions, and contusions. The latter may or may not be associated with intimal. injury. All can result in spasm, thrombosis, expanding hematoma, and distal thrombus embolization. Full-thickness injuries may result in false aneurysm, arteriovenous fistula, and life-threatening hemorrhage Neurological symptoms may develop secondary to ischemia, associated nerve injury, neural compression by expanding hematoma, or a compartment syndrome.

Diagnosis of vascular injury is sometimes difficult. This is especially true when a missile track is near a major vessel but distal pulses are still intact. Classically, a cold, pulseless extremity results from an arterial injury. Similar physical findings can occasionally be the result of environmental exposure, shock, arterial spasm, or crush injury. At times, an accurate diagnosis is not possible until exploration is undertaken. In most instances, however, the following signs and symptoms (commonly referred to as the 5 Ps) may be taken as presumptive evidence of arterial injury: pain, pallor, pulselessness, paresthesia, and paralysis. Additional findings may include contracture, mottling, and cyanosis. Anesthesia or external hemorrhage may or may not be present. In some cases, the injured limb may be clearly larger than the uninjured limb due to the presence of a large subfascial hematoma.

For the most part, the surgeon will have to rely solely on clinical skills in diagnosing and evaluating postoperative patency of arterial repairs. However, during the Vietnam conflict, it was shown that the Doppler instrument could be used effectively in the combat setting. Nowadays, sturdy, lightweight, and inexpensive instruments are widely available, and will in all likelihood be available in combat zone hospitals.

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Operational Medicine 2001

Health Care in Military Settings

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