Endovascular Management of Acute Extremity Trauma

Trauma is the fourth leading cause of mortality across all age groups and the leading cause of death for individuals less than 45 years of age.[1] In the United States, penetrating trauma from gunshot and stab wounds causes 75 to 95% of peripheral vascular injuries. Nonpenetrating vascular trauma secondary to traction, dislocations, fractures, and crush injuries accounts for the remaining 5 to 25% of vascular injuries.[2] [3]

The most common peripheral arteries injured are the brachial (30%) and femoropopliteal (50–60%).[4] [5] [6] Traditionally, extremity vascular trauma has been managed by open vascular repair; however, the utilization of minimally invasive endovascular therapies is increasing in prevalence. The National Trauma Data Bank reported a 10-fold increase in the rate of endovascular management of lower extremity vascular trauma from 2002 to 2016.[7] [8] From 2013 to 2019 alone, there was a recorded average 10% annual increase in endovascular interventions for trauma.[9] This increase in prevalence of application is paired with reduced amputation rates, complications (blood loss, infection risk, and iatrogenic injuries to adjacent neurovascular structures), and duration of hospitalization compared with open techniques, despite application to a patient population with high injury severity scores.[6] [9] [10] [11] [12] [13]

Recognized vascular injury patterns include intimal injury, pseudoaneurysm, transection with hemorrhage or occlusion, and arteriovenous fistulas.[5] Endovascular treatment options for extremity vascular injuries include stent graft placement and trans-arterial embolization when vessel sacrifice is appropriate. The purpose of this article is to provide a comprehensive review of extremity vascular trauma, including appropriate patient selection, diagnostic workup, endovascular repair techniques, intra-procedural considerations, and postprocedural management.

Publikationsverlauf

Artikel online veröffentlicht:
26. September 2025

• References

• 1 Curtin SC, Tejada-Vera B, Bastian BA. . National Vital Statistics Reports Volume 73, Number 4 April 8, 2024 Deaths: Leading Causes for 2021 [Internet]. Vol. 73. Accessed April 2024 at: https://www.cdc.gov/nchs/products/index.htm
• 2 Cooper C, Rodriguez A, Omert L. Blunt vascular trauma. Curr Probl Surg 1992; 29 (05) 281-357
• 3 Rozycki GS, Tremblay LN, Feliciano DV, McClelland WB. Blunt vascular trauma in the extremity: diagnosis, management, and outcome. J Trauma 2003; 55 (05) 814-824
• 4 Mattox KL, Feliciano DV, Burch J, Beall Jr AC, Jordan Jr GL, De Bakey ME. Five thousand seven hundred sixty cardiovascular injuries in 4459 patients. Epidemiologic evolution 1958 to 1987. Ann Surg 1989; 209 (06) 698-705 , discussion 706–707
• 5 Feliciano DV, Moore FA, Moore EE. et al; Western Trauma Association/Critical Decisions in Trauma. Evaluation and management of peripheral vascular injury. Part 1. Western Trauma Association/critical decisions in trauma. J Trauma 2011; 70 (06) 1551-1556
• 6 Kuwahara JT, Kord A, Ray Jr CE. Penetrating extremity trauma endovascular versus open repair?. Semin Intervent Radiol 2020; 37 (01) 55-61
• 7 Abdou H, Ottochian M, DuBose JJ, Scalea TM, Morrison JJ, Kundi R. Contemporary management of lower extremity vascular trauma. J Vasc Surg 2021; 74 (03) e290
• 8 Worni M, Scarborough JE, Gandhi M, Pietrobon R, Shortell CK. Use of endovascular therapy for peripheral arterial lesions: an analysis of the National Trauma Data Bank from 2007 to 2009. Ann Vasc Surg 2013; 27 (03) 299-305
• 9 Magee GA, Dubose JJ, Inaba K, Lucero L, Dirks RC, O'Banion LA. Outcomes of vascular trauma associated with an evolution in the use of endovascular management. J Vasc Surg 2023; 78 (02) 405-410.e1
• 10 Khurana A, Quencer K, Saini A. et al. Endovascular interventions in the management of acute extremity trauma: a narrative review. Ann Transl Med 2021; 9 (14) 1197-1197
• 11 Weaver JJ, Chick JFB, Monroe EJ, Johnson GE. Life and limb: current concepts in endovascular treatment of extremity trauma. Semin Intervent Radiol 2021; 38 (01) 64-74
• 12 Johnson CA. Endovascular management of peripheral vascular trauma. Semin Intervent Radiol 2010; 27 (01) 38-43
• 13 Singh A, Kumar A, Kumar P, Kumar S, Gamanagatti S. “Beyond saving lives”: current perspectives of interventional radiology in trauma. World J Radiol 2017; 9 (04) 155-177
• 14 Kobayashi L, Coimbra R, Goes Jr AMO. et al. American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of peripheral vascular injuries. J Trauma Acute Care Surg 2020; 89 (06) 1183-1196
• 15 deSouza IS, Benabbas R, McKee S. et al. Accuracy of physical examination, ankle-brachial index, and ultrasonography in the diagnosis of arterial injury in patients with penetrating extremity trauma: a systematic review and meta-analysis. Acad Emerg Med 2017; 24 (08) 994-1017
• 16 Miller-Thomas MM, West OC, Cohen AM. Diagnosing traumatic arterial injury in the extremities with CT angiography: pearls and pitfalls. Radiographics 2005; 25 (spec. ISS., suppl 1): S133-S142
• 17 Jeph S, Ahmed S, Bhatt RD, Nadal LL, Bhanushali A. Novel use of interventional radiology in trauma. J Emerg Crit Care Med 2017; 1 (12) 1-40
• 18 Jens S, Kerstens MK, Legemate DA, Reekers JA, Bipat S, Koelemay MJW. Diagnostic performance of computed tomography angiography in peripheral arterial injury due to trauma: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2013; 46 (03) 329-337
• 19 Soto JA, Múnera F, Morales C. et al. Focal arterial injuries of the proximal extremities: helical CT arteriography as the initial method of diagnosis. Radiology 2001; 218 (01) 188-194
• 20 Bauer JR, Ray CE. Transcatheter arterial embolization in the trauma patient: a review. Semin Intervent Radiol 2004; 21 (01) 11-22
• 21 Inaba K, Branco BC, Reddy S. et al. Prospective evaluation of multidetector computed tomography for extremity vascular trauma. J Trauma 2011; 70 (04) 808-815
• 22 Lopera JE. Embolization in trauma: principles and techniques. Semin Intervent Radiol 2010; 27 (01) 14-28
• 23 O Dell MC, Shah J, Martin JG, Kies D. ODell MC. Emergent endovascular treatment of penetrating trauma: solid organ and extremity. Tech Vasc Interv Radiol 2017; 20 (04) 243-247
• 24 du Toit DF, Lambrechts AV, Stark H, Warren BL. Long-term results of stent graft treatment of subclavian artery injuries: management of choice for stable patients?. J Vasc Surg 2008; 47 (04) 739-743
• 25 Desai SS, DuBose JJ, Parham CS. et al. Outcomes after endovascular repair of arterial trauma. J Vasc Surg 2014; 60 (05) 1309-1314
• 26 Regine R, Palmieri F, De Siero M. et al. Embolization of traumatic and non-traumatic peripheral vascular lesions with Onyx. Interv Med Appl Sci 2015; 7 (01) 22-29
• 27 Cantasdemir M, Kantarci F, Mihmanli I, Numan F. Embolization of profunda femoris artery branch pseudoaneurysms with ethylene vinyl alcohol copolymer (Onyx). J Vasc Interv Radiol 2002; 13 (07) 725-728