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Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient’s life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed postoperatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. All permanent or temporary vascular procedures should be followed by a definitive repair within the first 8 hours. An early diagnosis and opportune intervention are fundamental to preserve the function and perfusion of the extremity.

Mario Alain Herrera, Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-4526-7636

Mauricio Millan, Universidad Icesi, Cali, Colombia. Division of Transplant Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-5502-5745

Ana Milena del Valle, Division of Surgery, Hospital Felix Bulness, Santiago de Chile, Chile.

https://orcid.org/0000-0002-6186-1440

Mateo Betancourt-Cajiao, Escuela de Medicina, Facultad de Salud, Universidad del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-5318-0397

Yaset Caicedo, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-6128-0128

Isabella Caicedo, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0003-2516-4004

Linda M. Gallego, Universidad Icesi, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-9081-5016

Diego Rivera, Centro Médico Imbanaco, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0003-4769-9384

Michael W Parra, Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA

orcid_id14.png https://orcid.org/0000-0001-6496-6275

Carlos Alberto Ordoñez, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0003-4495-7405

Herrera, M. A., Millan, M., del Valle, A. M., Betancourt-Cajiao, M., Caicedo, Y., Caicedo, I., Gallego, L. M., Rivera, D., Parra, M. W., & Ordoñez, C. A. (2021). Damage control of peripheral vascular trauma - Don’t be afraid of axillary or popliteal fosses. Colombia Médica, 52(2), e4074735. https://doi.org/10.25100/cm.v52i2.4735

White JM, Stannard A, Burkhardt GE, Eastridge BJ, Blackbourne LH, Rasmussen TE. The epidemiology of vascular injury in the wars in Iraq and Afghanistan. Ann Surg 2011;253:1184–9. https://doi.org/10.1097/SLA.0b013e31820752e3.

Muckart DJJ, Pillay B, Hardcastle TC, Skinner DL. Vascular injuries following blunt polytrauma. Eur J Trauma Emerg Surg 2014;40:315–22. https://doi.org/10.1007/s00068-014-0382-y.

Friend J, Rao S, Sieunarine K, Woodroof P. Vascular trauma in Western Australia: A comparison of two study periods over 15 years. ANZ J Surg 2016;86:173–8. https://doi.org/10.1111/ans.12309.

Konstantinidis A, Inaba K, Dubose J, Barmparas G, Lam L, Plurad D, et al. Vascular trauma in geriatric patients: A National Trauma Databank review. J Trauma - Inj Infect Crit Care 2011;71:909–16. https://doi.org/10.1097/TA.0b013e318204104e.

Sonneborn R, Andrade R, Bello F, Morales-Uribe CH, Razuk A, Soria A, et al. Vascular trauma in Latin America: A regional survey. Surg Clin North Am 2002;82:189–94. https://doi.org/10.1016/S0039-6109(03)00148-8.

Mattox KL, Feliciano D V., Burch J, Beall AC, Jordan GL, Debakey ME. Five thousand seven hundred sixty cardiovascular injuries in 4459 patients: Epidemiologic evolution 1958 to 1987. Ann Surg 1989;209:698–707. https://doi.org/10.1097/00000658-198906000-00007.

Baker AC, Clouse WD. Upper Extremity and Junctional Zone Injuries. Rich’s Vasc. Trauma, Elsevier Inc.; 2015, p. 149–67. https://doi.org/10.1016/B978-1-4557-1261-8.00014-X.

Espinoza E, Castañeda E. Caracteristicas clinicas de los traumas vasculares perifericos en pacientes atendidos en un hospital general de Lima, Peru. Rev Medica Hered 2014;25:122–8.

Montoya-Reales DA, Ochoa J. Características clínicas del trauma vascular periférico en pacientes atendidos en el Hospital Escuela Universitario, Honduras. Rev Méd Hondur 2015:33–7.

Ockert S, Winkler M, Richter A, Palma P, Post S. Gefäßverletzungen nach extremitätentrauma. Zentralbl Chir 2002;127:689–93. https://doi.org/10.1055/s-2002-33575.

Diamond S, Gaspard D, Katz S. Vascular injuries to the extremities in a suburban trauma center. Am. Surg., vol. 69, Am Surg; 2003, p. 848–51.

DuBose JJ, Savage SA, Fabian TC, Menaker J, Scalea T, Holcomb JB, et al. The American association for the surgery of trauma prospective observational vascular injury treatment (PROOVIT) registry: Multicenter data on modern vascular injury diagnosis, management, and outcomes. J. Trauma Acute Care Surg., vol. 78, Lippincott Williams and Wilkins; 2015, p. 215–23. https://doi.org/10.1097/TA.0000000000000520.

D’Alessio I, Domanin M, Bissacco D, Romagnoli S, Rimoldi P, Sammartano F, et al. Operative Treatment and Clinical Outcomes in Peripheral Vascular Trauma: The Combined Experience of Two Centers in the Endovascular Era. Ann Vasc Surg 2020;62:342–8. https://doi.org/10.1016/j.avsg.2019.06.037.

Advanced trauma life support (ATLS): 10th Edition. 2018. https://doi.org/10.1111/j.1365-2044.1993.tb07026.x.

Kobayashi L, Coimbra R, Goes AMOJ, Reva V, Santorelli J, Moore EE, et al. AAST - WSES Guidelines on Diagnosis and Management of Peripheral Vascular Injuries. J Trauma Acute Care Surg 2020. https://doi.org/10.1097/TA.0000000000002967.

Moore EE, Cogbill TH, Jurkovich GJ, McAninch JW, Champion HR, Gennarelli TA, et al. Organ injury scaling. III: Chest wall, abdominal vascular, ureter, bladder, and urethra. J Trauma 1992;33:337–9.

Salamea JC, Himmler A, Valencia-Angel LI, Ordoñez CA, Parra M, Caicedo Y, et al. Whole Blood for Blood Loss: Hemostatic Resuscitation in Damage Control. Colomb Med 2020;16:2014511. https://doi.org/10.25100/cm.v51i4.4511.

Melendez JJ, Caicedo Y, Guzman M, Serna JJ, Ordoñez J, Angamarca E, et al. Prehospital Damage Control: The Management of Volume, Temperature…and Bleeding! Colomb Med 2020;51:2014486. https://doi.org/10.25100/cm.v51i4.4486.

Ordoñez CA, Parra M, Caicedo Y, Padilla N, Rodriguez F, Serna JJ, et al. REBOA as a New Damage Control Component in Hemodynamically Unstable NTCH patients. Colomb Med 2020.

Ordoñez CA, Parra MW, Serna JJ, Rodríguez H F, García AF, Salcedo A, et al. Damage Control Resuscitation : REBOA as the New Fourth pillar. Colomb Med 2020. https://doi.org/10.25100/cm.v51i4.4353.

Liu JL, Li JY, Jiang P, Jia W, Tian X, Cheng ZY, et al. Literature review of peripheral vascular trauma: Is the era of intervention coming? Chinese J Traumatol - English Ed 2020;23:5–9. https://doi.org/10.1016/j.cjtee.2019.11.003.

Ganapathy A, Khouqeer AF, Todd SR, Mills JL, Gilani R. Endovascular management for peripheral arterial trauma: The new norm? Injury 2017;48:1025–30. https://doi.org/10.1016/j.injury.2017.02.002.

Ditzel RM, Anderson JL, Eisenhart WJ, Rankin CJ, DeFeo DR, Oak S, et al. A review of transfusion- And trauma-induced hypocalcemia: Is it time to change the lethal triad to the lethal diamond? J Trauma Acute Care Surg 2020;88:434–9. https://doi.org/10.1097/TA.0000000000002570.

Mullenix PS, Steele SR, Andersen CA, Starnes BW, Salim A, Martin MJ. Limb salvage and outcomes among patients with traumatic popliteal vascular injury: An analysis of the National Trauma Data Bank. J Vasc Surg 2006;44:94–100. https://doi.org/10.1016/j.jvs.2006.02.052.

Ratnayake A, Samarasinghe B, Bala M. Outcomes of popliteal vascular injuries at Sri Lankan war-front military hospital: Case series of 44 cases. Injury 2014;45:879–84. https://doi.org/10.1016/j.injury.2014.01.003.

Pourzand A, Fakhri BA, Azhough R, Hassanzadeh MA, Hashemzadeh S, Bayat AM. Management of high-risk popliteal vascular blunt trauma: Clinical experience with 62 cases. Vasc Health Risk Manag 2010;6:613–8. https://doi.org/10.2147/vhrm.s11733.

Fortuna G, DuBose JJ, Mendelsberg R, Inaba K, Haider A, Joseph B, et al. Contemporary outcomes of lower extremity vascular repairs extending below the knee: A multicenter retrospective study. J. Trauma Acute Care Surg., vol. 81, Lippincott Williams and Wilkins; 2016, p. 63–9. https://doi.org/10.1097/TA.0000000000000996.

Gopinathan N, Santhanam S, Saibaba B, Dhillon M. Epidemiology of lower limb musculoskeletal trauma with associated vascular injuries in a tertiary care institute in India. Indian J Orthop 2017;51:199–204. https://doi.org/10.4103/0019-5413.201702.

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