{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:58:08Z","timestamp":1787237888379,"version":"build-2736575974"},"reference-count":35,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2017,5,13]]},"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:p>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.<\/jats:p>\n                  <jats:p>The pitfall to avoid during evaluation of the patient in the emergency center is a missed diagnosis. In the patient without \u2018hard\u2019 signs of a peripheral vascular injury, a careful history (bleeding), physical examination including measurement of ankle\u2013brachial (ABI) or brachial\u2013brachial index and liberal use of CT arteriography depending on an ABI &lt;0.9\u2009should essentially make the diagnosis if an arterial injury is present.<\/jats:p>\n                  <jats:p>At operation, one pitfall is to limit skin preparation and draping, thereby eliminating the option of removing the greater saphenous vein if needed as a conduit from either the groin or ankle of an uninjured lower extremity. Another pitfall is to make a full longitudinal incision directly over a large pulsatile hematoma. Rather, separate shorter longitudinal incisions should be made to obtain proximal and distal vascular control before entering the hematoma. The failure to recognize patients who should be managed initially with insertion of a temporary intraluminal shunt is a major pitfall as well. Not following time-proven and results-proven \u2018fine techniques\u2019 of operative repair is another major pitfall. Such techniques include the following: use of small angioaccess vascular clamps or silastic vessel loops; passage of proximal and distal Fogarty catheters; administration of regional or systemic heparin during complex repairs; an open anastomosis technique; and completion arteriography after a complex arterial repair in a lower extremity.<\/jats:p>\n                  <jats:p>Avoiding pitfalls should allow for success in peripheral vascular repair, particularly since most patients are young with non-diseased vessels.<\/jats:p>","DOI":"10.1136\/tsaco-2017-000110","type":"journal-article","created":{"date-parts":[[2017,8,28]],"date-time":"2017-08-28T20:10:40Z","timestamp":1503951040000},"page":"e000110","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":45,"title":["Pitfalls in the management of peripheral vascular injuries"],"prefix":"10.1136","volume":"2","author":[{"given":"David V","family":"Feliciano","sequence":"first","affiliation":[{"name":"Division of General Surgery, Indiana University Medical Center, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,8,28]]},"reference":[{"key":"2025082410151746000_2.1.e000110.1","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1097\/TA.0b013e3182827035","article-title":"Limb salvage after complex repairs of extremity arterial injuries is independent of surgical specialty training","volume":"74","author":"Shackford","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410151746000_2.1.e000110.2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199104000-00009"},{"key":"2025082410151746000_2.1.e000110.3","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199802000-00001"},{"key":"2025082410151746000_2.1.e000110.4","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1989.01410100034007"},{"key":"2025082410151746000_2.1.e000110.5","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000220372.85575.e2"},{"key":"2025082410151746000_2.1.e000110.6","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31816b6564"},{"key":"2025082410151746000_2.1.e000110.7","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1097\/TA.0b013e3182569df4","article-title":"Tourniquets, vascular shunts, and endovascular technologies: esoteric or essential? 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