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.
Keywords
interventional radiology - trauma - extremity trauma - vascular injury - endovascular
- vascular surgery
