Department of hand surgery & Microsurgery.

Artery Injury

What is vascular trauma?

A vascular trauma is an injury to an artery or vein due to a trauma or blow. These injuries are most often located on a limb, especially lower ones (80-90% of cases). Early detection and treatment is crucial to prevent limb amputation, as well as to improve prognosis for the patient.

What are the causes of vascular trauma ?

Vascular injuries may be classed as penetrating or non-penetrating:

  • Penetrating trauma.: The injury is caused by a foreign object piercing or crushing the skin (e.g. in armed conflicts this tends to be sharp and pointy objects). These may cause a blood vessel to rupture, cause bleeding and a haemorrhage, or cause thrombosis (blood clot).
  • Non-penetrating trauma. The injury may be caused by tissue compression or a sudden deceleration. The vessel wall structure breaks, which can result in tearing and thrombosis.
What are the symptoms of vascular trauma?

Vascular injury symptoms are often classified into serious or not serious.Serious symptoms include:

  • Absence of distal pulse.
  • Active haemorrhage
  • Acute ischemia
  • Pulsating haematoma (localised bleeding outside of a blood vessel)

Less serious symptoms include:

  • Decreased distal pulse
  • Injury near an important blood vessel
  • High blood pressure or shock
  • Neurological defect.
What are the commonly injured arteries in the upper limb ?

Commonly injured blood vessels are brachial artery, radial artery and ulnar artery.

Medical tests

Your doctor will have to physically examine the patient’s general state, the location of the injuries, the degree of haemodynamic stability (the movement of blood), if there are any bone or joint injuries, if there is a haemorrhage or ischaemia, the colour and temperature of limbs, weakness of muscles or altered sensations beyond the level of injury.

Diagnostic tests can help confirm hidden injuries and help establish the best surgical approach:

  • Non-invasive vascular tests such as the Doppler ultrasound to rule out non-visible arterial damage or to confirm permeability of the arterial tree in patients that are difficult to examine due to oedema or open injuries.
  • An X-ray of the chest or limbs will help give more information about a potential vascular injury.
  • Computerised angiotomography or MR angiography MRA. These enable the early diagnosis of vascular injuries, and are particularly useful for diagnosing cervical, abdominal, and thoracic injuries.
  • Arteriography is the standard test for diagnosing vascular injuries. It allows the location and extension of the injury to be known, as well as what vessels are affected. It also works as access to and control of damaged vessels.
What causes vascular injuries?

The most common vascular injuries are impacts to the blood vessels. The most common of these include motor vehicle accidents, work, and home accidents. On rare occasions, the vascular injury may be caused by trauma such as a stab wound.

What is the treatment?

The blood vessel carries blood to the limb. An injury will obliterate or reduce the blood flow to the limb. Depending on the vessel injured and the extent of injury; your surgeon will decide on the most suitable treatment, after discussing with you and your relatives. Treatment options include direct vascular suture, bypass with vein or prosthesis, and vessel ligation.