Semin intervent Radiol 2021; 38(01): 064-074
DOI: 10.1055/s-0041-1724011
Review Article

Life and Limb: Current Concepts in Endovascular Treatment of Extremity Trauma

John J. Weaver
1  Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
,
Jeffrey F.B. Chick
1  Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
,
Eric J. Monroe
1  Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
2  Division of Interventional Radiology, Department of Radiology, Seattle Children's Hospital, Seattle, Washington
,
Guy E. Johnson
1  Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
› Author Affiliations

Abstract

Traumatic injury is the leading cause of death worldwide in younger patient populations and extremity trauma with associated vascular injury accounts for many trauma-related deaths. Iatrogenic injury is also a common cause of extremity vascular trauma and the incidence of iatrogenic injury will likely increase as endovascular techniques continue to become more ubiquitous. For many vascular injuries involving the extremities, surgical repair is viewed as the standard of care. Historically, endovascular techniques did not play a role in the treatment of these vascular injuries, rather they were utilized only as part of the diagnostic assessment; however, there is an increasing trend toward endovascular management of extremity vascular trauma. No validated, widely implemented algorithm to select patients for endovascular intervention exists. Transcatheter techniques, however, play an important role in the management of these patients. For arterial injuries, embolization can be used to rapidly achieve hemostasis if the vessel can be sacrificed. More advanced endovascular techniques such as stent-graft placement may be best employed in the context of isolated, proximal extremity injuries, although there is increasing literature supporting the use of advanced techniques for more distal arterial injuries. The management of peripheral venous trauma remains controversial; however, there is growing data describing successful endovascular management of some peripheral venous injuries. The purpose of this article is to review extremity vascular trauma, concepts of injury triage, endovascular techniques, and intraprocedural considerations.

Contribution

All authors have read and contributed to this manuscript.


Disclosure

J.F.B.C. is a consultant and speaker for Guerbet and C. R. Bard.


E.J.M. is a scientific advisor and speaker for Biogen.


G.E.J. is an advisor for Boston Scientific Corporation and Genentech.


Remaining authors have no relevant disclosures.




Publication History

Publication Date:
15 April 2021 (online)

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