Self-assessment Questions

12 Arterial disease

• 1. What are the two general types of arterial trauma?

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  Traumatic arterial injuries are due to either closed (blunt) trauma or open (penetrating) trauma.

• 2. What is a closed arterial injury? Give three examples

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  The artery is injured by extraneous compression such as a crush injury, fractures of adjacent bones with displacement of the artery (e.g. supracondylar fracture of the humerus in children) or joint dislocation. Iatrogenic causes include a tight plaster of Paris cast in which no allowance has been made for post-traumatic oedema.

• 3. What is a penetrating arterial injury? Give some examples

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  Penetrating arterial injuries may result from gunshot wounds, stabbing, penetration by bone spicules in fractures or iatrogenic injury.

• 4. What are the three general types of arterial injury?

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  Mural contusion with secondary spasm; intimal tear; full thickness tear

• 5. What is the commonest cause of an intimal tear arterial injury? What happens when there is an intimal tear?

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  This injury is usually the result of distraction, where the artery is stretched and the intimal layer tears, while the surrounding adventitia remains intact. The intima then buckles and causes a localized stenosis, which may or may not result in thrombosis or dissection.

• 6. What are the characteristics of a full thickness arterial tear?

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  Correct answer:

  All layers of the artery are divided, and this may be partial or complete. Partial tears bleed copiously, while complete division of the artery often results in contracture and spasm of the divided vessel with surprisingly little blood loss.

• 7. In terms of bleeding, which type of full thickness arterial tear bleeds most: partial or complete?

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  Partial will bleed more. A complete division results in contraction and spasm and surprisingly does not bleed as much.

• 8. What are the six main complications of an arterial injury?

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  Correct answer:

  (1) Haemorrhage. (2) Thrombosis. (3) Arteriovenous fistula. (4) False (pseudo-) aneurysm formation. (5) Arterial dissection. (6) Compartment syndrome.

• 9. What is compartment syndrome?

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  Correct answer:

  Ischaemic muscle swells and if the muscle is contained by a fibrous fascial compartment, such as in the forearm or in the lower leg, the swelling further exacerbates the ischaemia by an increased compartment pressure.

• 10. What causes Volkmann’s ischaemic contracture?

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  Correct answer:

  Compartment syndrome.

• 11. What are the clinical features of arterial injury?

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  The features of arterial injury may be those of acute ischaemia, haemorrhage or often both. Acute ischaemia is characterized by: pain (in the limb supplied, starting distally and progressing proximally), pallor, pulselessness, paraesthesiae, paralysis, coldness. Haemorrhage may be overt (bright red blood), or concealed (e.g. closed limb fractures). Symptoms are those of rapidly developing hypovolaemic shock (cold, clamminess, tachycardia, hypotension, loss of consciousness, oliguria progressing to anuria).

• 12. What are the clinical features of acute ischaemia?

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  Correct answer:

  The five Ps: Pain (in the limb supplied, starting distally and progressing proximally), Pallor, Pulselessness, Paraesthesiae, Paralysis, plus coldness.