Penetrating vascular injury is becoming increasingly common in the United States and abroad. Much of the current research and treatment is derived from wartime and translation to the civilian sector has been lacking. Penetrating vascular injury can be classified as extremity, junctional, or noncompressible. Diagnosis can be obvious but at other times subtle and difficult to diagnose. Although there are numerous modalities, computed tomography angiography is the diagnostic study of choice. It is hoped that care will be improved by using an algorithmic approach integrating experience from military and civilian research.
Key points
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Penetrating vascular injury is increasing and becoming more important in emergency medicine (EM). The extent of a projectile injury depends on mass, velocity, and characteristics.
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Hard signs are usually treated operatively. Soft signs or asymptomatic patients warrant further workup. There are numerous diagnostic modalities; computed tomography angiography is the gold standard.
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Direct pressure is the most important hemorrhage control but others are reviewed.
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Resuscitation of these patients should focus on balance component therapy, prevention of coagulopathy, and permissive hypotension when allowable.
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There are numerous complications other than the vascular injury alone and EM physicians must be cognizant of these. Always thoroughly document a neurovascular examination.
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