The author presents a review of the approach of vascular surgeons to penetrating injuries of the extremities from the initial period of development of the discipline when surgical exploration was preferred and performed as a matter of routine, across the sixties, seventies and eighties characterized by universal use of angiography, up to the last decade and the present time when specialists accept the necessity of selective indication of angiography derived from the clinical picture. Certain persisting differences in views pertain only to some aspects of the clinical finding. Some authors were for instance concerned with investigation of the probable risk of arterial injuries with regard to the site of penetration, from their conclusion ensues in the great majority the recommendation to perform angiography in injuries of the medial side of the thigh and arm, popliteal area, leg and forearm, incl. asymptomatic ones. Other investigations sought a relationship between the incidence of injuries and the presence of some clinical symptoms and recommend to indicate angiography in injuries associated with at least one "hard" symptom (pulse or neurological ischaemic deficiency) or at least two "soft" symptoms (haematoma, haemorrhage, hypotension, malleobrachial index smaller than 1). The author presents also his own attitude to the problem and emphasizes expert comprehensive clinical examination, taking into account the site of penetration, character and mechanism of injury, character of clinical symptoms, their intensity in relation to the general state of the circulation and its possible changes, in selected cases supplementation of the clinical finding by sonographic examination.

Chirurgické oddĕlení UVN Praha