Editing Vascular trauma (section)

= Limb =

* Presence of hard signs of vascular injury mandates exploration (except AVF)
* Soft signs or AVF should mandate CTA
* Hybrid theatre if possible
* If the injury results in little or no loss of length, repair primarily in transverse fashion with proline. Patch angioplasty or segmental interposition grafting may be required.
* Brachial - explore via medial longitudinal incision positioned in the groove between the biceps and triceps muscle
* Isolated radial or ulnar artery injuries can be ligated, but check there is flow in the collateral vessel with USS prior to ligation. If combined radial and ulnar injury, need to repair one of them (mostly the ulnar artery is larger, at least in the proximal forearm).
* SFA - expose in a plane in front of the anterior edge of the sartorius muscle. Most injuries require interposition grafting. 
* SFV - repair if feasible, but can be ligated.
* CFV - repair when possible.
* If doing major venous ligation, give strong consideration to calf fasciotomy.
* Popliteal - need high index of suspicion in hyperextension injury, as pulse examination is often benign. CTA is indicated in traumatic knee dislocation. Bypass grafting is generally required - contralateral vein is generally preferred, but a short interposition graft e.g. PTFE is acceptable. Fasciotomy considered. 
* Tibial artery - can be sacrificed if remaining vessels are patent. If multiple injured, vein interposition grafting is necessary to the one best supplying the foot.