It’s 2 a.m. and a patient with a GSW to the thigh is rolling into the trauma bay. He’s hypotensive, tachycardic, and has a tourniquet in place. Do you get a CTA or go straight to the OR? What do you do with the tourniquet? Join us as we work through this and two other cases of extremity vascular trauma and break down the literature to answer these questions and discuss how we should approach these challenging injuries. Hosts:· Christian Hadeed - PGY 5 General Surgery, Brookdale Hospital Medical Center· Paul Haser -Division Chief, Vascular Surgery, Brookdale Hospital Medical Center· Andrew Harrington – Division Chief, Vascular surgery, Richmond University Medical Center· Lucio Flores - Vascular surgery, Brookdale Hospital Medical Center Learning Objectives:· Apply the X-ABCDE approach to patients with extremity vascular trauma, including the role of early hemorrhage control and tourniquets.· Recognize the hard and soft signs of extremity arterial injury and determine when additional vascular imaging is indicated.· Describe the role of the ankle-brachial index, CT angiography, and conventional angiography in the evaluation of suspected extremity vascular injury.· Discuss the principles of operative management of extremity vascular injuries, including temporary shunting, vascular repair, and restoration of limb perfusion.· Briefly discuss mangles extremities and when saving the limb may not be appropritate References:· American College of Surgeons Committee on Trauma. (2025). Advanced trauma life support (ATLS®) student course manual (11th ed.). American College of Surgeons.· Lynch, K., & Johansen, K. (1991). Can Doppler pressure measurement replace “exclusion” arteriography in the diagnosis of occult extremity arterial trauma? Annals of Surgery, 214(6), 737–741. https://doi.org/10.1097/00000658-199112000-00016· Inaba, K., Branco, B. C., Reddy, S., Park, J. J., Green, D., Plurad, D., Talving, P., Lam, L., & Demetriades, D. (2011). Prospective evaluation of multidetector computed tomography for extremity vascular trauma. Journal of Trauma, 70(4), 808–815. https://doi.org/10.1097/TA.0b013e3182118384· Polcz, J. E., White, J. M., Ronaldi, A. E., Dubose, J. J., Grey, S., Bell, D., White, P. W., & Rasmussen, T. E. (2021). Temporary intravascular shunt use improves early limb salvage after extremity vascular injury. Journal of Vascular Surgery, 73(4), 1304–1313. https://doi.org/10.1016/j.jvs.2020.08.137· Asensio, J. A., Kessler, J. J., Miljkovic, S. S., Kotaru, T. R., Dabestani, P. J., Kalamchi, L. D., Wenzl, F. A., Sanford, A. P., & Rowe, V. L. (2020). Brachial artery injuries: Operative management and predictors of outcome. Annals of Vascular Surgery, 69, 146–157. https://doi.org/10.1016/j.avsg.2020.05.049· Barnes, C. J., Pietrobon, R., & Higgins, L. D. (2002). Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury? A meta-analysis. Journal of Trauma, 53(6), 1109–1114. https://doi.org/10.1097/00005373-200212000-00013· Mills, W. J., Barei, D. P., & McNair, P. (2004). The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: A prospective study. Journal of Trauma, 56(6), 1261–1265. https://doi.org/10.1097/01.TA.0000068995.63201.0B· Weinberg, D. S., Scarcella, N. R., Napora, J. K., & Vallier, H. A. (2016). Can vascular injury be appropriately assessed with physical examination after knee dislocation? Clinical Orthopaedics and Related Research, 474, 1453–1458. https://doi.org/10.1007/s11999-016-4730-6Sponsor URL: https://www.goremedical.com/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. 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