Pitfalls in the management of peripheral vascular injuries

Over the past 65+ years, most civilian peripheral vascular injuries have been managed by trauma surgeons with training or experience in vascular repair or ligation. This is appropriate as the in-hospital trauma team is immediately available, and there are often other injuries present in the victim. The pitfall to avoid during evaluation of the patient in the emergency center is a missed diagnosis. In the patient without 'hard' signs of a peripheral vascular injury, a careful history (bleeding), physical examination including measurement of ankle-brachial (ABI) or brachial-brachial index and liberal use of CT arteriography depending on an ABI