Pre-existing peripheral arterial disease in trauma.

Patients with PAD tend to be much older physiologically than patients of the same chronologic age who do not have vascular disease. In addition, patients with vascular disease in one system tend to have vascular disease in other areas of the body, especially in the vessels supplying the heart and brain. Many also have pre-existing pulmonary and renal dysfunction. Even if trauma does not involve any diseased vessels, the hypotension that often occurs with major injuries may cause thrombosis of vessels that have a critical degree of stenosis. If a diseased vessel is injured, direct reconstruction may be difficult or impossible and a bypass may have to be performed. If this is not feasible in a severely injured lower extremity, early amputation may be the safest option. Even if the initial trauma is handled very well, patients with vascular disease tend to have an increased incidence of complications and death, and such patients require careful intensive care unit monitoring for at least 2 to 3 days.