Angiography and endovascular intervention for vascular trauma to the extremities

Vascular trauma to the extremities is less frequently lethal and more commonly penetrating than thoracoabdominal trauma. Arteriography is indispensable in the evaluation of stable patients with hard physical findings or a positive finding on one of a growing variety of noninvasive diagnostic modalities. However, it is not indicated in unstable patients with obvious vascular injury and it is controversial when used in patients with soft findings or simply a penetrating injury in close proximity to a major vascular structure. Arteriography provides access for an increasing array of endovascular treatment options. Embolization can effectively halt bleeding from small- and medium-sized arterial branches where preservation of flow is not crucial. Covered stents and stent grafts can successfully treat lesions in larger arteries where flow must be preserved, but these are off-label uses where the short-term benefit of avoiding difficult or hazardous surgical access must be weighed against disappointing long-term patency rates, especially when a young patient is involved. Intra-arterial vasodilators can be very useful in patients with critical ischemia due to arterial spasm and local low flow states resulting from severe extremity injuries.