TY - JOUR T1 - Arterial and venous injuries: the combined injury conundrum JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000746 VL - 6 IS - 1 SP - e000746 AU - David J Skarupa AU - Matthew P Kochuba AU - David V Feliciano Y1 - 2021/04/01 UR - http://tsaco.bmj.com/content/6/1/e000746.abstract N2 - A 35-year-old man presented to the trauma center with two gunshot wounds to the left thigh that were reportedly from a handgun. Prehospital transport time was about 15 minutes and he received 1 L of intravenous crystalloid fluid for hypotension. It was reported that the patient fell after he was shot and that he hit his head and lost consciousness.The patient was pale and diaphoretic on arrival at the trauma center. His blood pressure was 83/53, heart rate was 82 beats per minute, respiratory rate was 18 breaths per minute, and oxygen saturation was 98% on room air. There was a missile wound in the proximal lateral left thigh and another in the distal posterior thigh. He had hard signs of an arterial injury in the left thigh, including arterial bleeding from the distal gunshot wound, an expanding hematoma, and a pulseless left foot, as well as decreased motor function and sensation in the left foot.A massive transfusion protocol was initiated as X-rays of the left lower extremity were completed (no fracture). After pressure dressing was applied to the site of hemorrhage in the left thigh (distal gunshot wound), the patient was taken to the CT scanner to evaluate for a traumatic brain injury and then to the operating room emergently for exploration of the left thigh.Skin preparation was applied from the umbilicus to the toes bilaterally and was circumferential on the lower extremities. An incision was made along the left medial thigh to expose the superficial femoral artery (SFA). Nearly circumferential injuries to the distal SFA and popliteal vein at the adductor hiatus (Hunter’s canal) were identified. Proximal and distal control with the application of vascular clamps to both vessels was obtained, and systemic heparin (7000 units, or approximately 100 U/kg) was administered … ER -