Arterial injury
Incidence
0.05%
Types
1. Thrombosis
- most common scenario
- tourniquet with atherosclerosis
- indirect damage to vessel
- femoral or popliteal
2. Embolisation
- atherosclerosis again
- blue toes syndrome post operatively
3. Vessel transection
Presentation
- acute ischaemia post operatively
- traumatic aneurysm
- AV fistula
Management
- on table angiogram
- externally rotate leg
- medial approach to posterior knee
- detach medial head of gastrocnemius
- direct artery repair / venous patch / venous or synthetic bypass
Problems
- 25-50% amputation rate
- deep infection and sepsis
- wound healing issues
History
Beware
- symptoms arterial insufficiency
- rest pain, intermittent claudication
- bypass surgery to heart or leg
- diabetic patients
Examination
Trophic skin changes
Feel for popliteal aneurysm
Feel for pedal pulses
Management absent pedal pulses
ABI > 0.5
- do without tourniquet
- vascular consult
- may require immediate postoperative surgery
ABI < 0.5
- need bypass surgery first
- certainly need pre-op angiogram