title: Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of Trauma practice management guideline.
abstract: BACKGROUND
  Extremity arterial injury after penetrating trauma is common in military conflict or urban trauma centers. Most peripheral arterial injuries occur in the femoral and popliteal vessels of the lower extremity. The Eastern Association for the Surgery of Trauma first published practice management guidelines for the evaluation and treatment of penetrating lower extremity arterial trauma in 2002. Since that time, there have been advancements in the management of penetrating lower extremity arterial trauma. As a result, the Practice Management Guidelines Committee set out to develop updated guidelines.
  
  
  METHODS
  A MEDLINE computer search was performed using PubMed (www.pubmed.gov). The search retrieved English language articles regarding penetrating lower extremity trauma from 1998 to 2011. References of these articles were also used to locate articles not identified through the MEDLINE search. Letters to the editor, case reports, book chapters, and review articles were excluded. The topics investigated were prehospital management, diagnostic evaluation, use of imaging technology, the role of temporary intravascular shunts, use of tourniquets, and the role of endovascular intervention.
  
  
  RESULTS
  Forty-three articles were identified. From this group, 20 articles were selected to construct the guidelines.
  
  
  CONCLUSIONS
  There have been changes in practice since the publication of the previous guidelines in 2002. Expedited triage of patients is possible with physical examination and/or the measurement of ankle-brachial indices. Computed tomographic angiography has become the diagnostic study of choice when imaging is required. Tourniquets and intravascular shunts have emerged as adjuncts in the treatment of penetrating lower extremity arterial trauma. The role of endovascular intervention warrants further investigation.
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Cooper University Hospital, Camden, New Jersey 08103, USA. fox-nicole@cooperhealth.edu
authors.forename: Nicole
authors.initials: N
authors.lastname: Fox
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Rajani
authors.forename: Faran
authors.initials: F
authors.lastname: Bokhari
authors.forename: William C
authors.initials: WC
authors.lastname: Chiu
authors.forename: Andrew
authors.initials: A
authors.lastname: Kerwin
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Seamon
authors.forename: David
authors.initials: D
authors.lastname: Skarupa
authors.forename: Eric
authors.initials: E
authors.lastname: Frykberg
mesh_terms: D000792:Angiography / Q000592:standards; D055109:Ankle Brachial Index / Q000592:standards; D001158:Arteries / Q000293:injuries*; D001807:Blood Vessel Prosthesis; D006801:Humans; D007866:Leg / Q000098:blood supply; D007869:Leg Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014111:Tourniquets / Q000592:standards; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*