Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XVIII: Vascular Injuries
United States Department of Defense
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The management objective of arterial injuries is restoration of arterial flow at the earliest possible moment. As the time lag from injury to repair increases, so increases the failure rate of arterial repair. While the best results are obtained when blood flow is reestablished within six hours of injury, it remains impossible to define the precise time beyond which successful repair can be expected. Thus, there is no inflexible time limit beyond which arterial repair is absolutely contraindicated.
When occlusion of a major artery occurs as a result of trauma, limb viability depends on collateral circulation. Whether or not operation can be delayed in such cases is dependent upon the adequacy of collateral blood flow. Irreversible muscle damage may occur within a few hours if collateral circulation is inadequate. On the other hand, limb survival may occur without arterial repair in some cases solely on the basis of collateral blood flow. In such cases, false aneurysms and arteriovenous fistulae may present as delayed manifestations of the acute injury. Since it is usually not possible to determine the irreversibility of ischemic damage by clinical means, repair of major blood vessel injuries should be performed even in questionable cases if support is available Although the entire limb might not be salvaged, a more distal level of amputation may result.
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