Which of the following statement(s) is/are true concerning the surgical management of vascular injuries?

b. Systemic heparinization must be avoided in patients with multiple injuries

d. Venous repair should not be attempted in a hemodynamically unstable patient

The goal of operative management of vascular injuries is the rapid control of hemorrhage and the restoration of perfusion, with salvage of extremity or organ in jeopardy. In isolated-extremity vascular injury with arterial occlusion, systemic heparin should be administered to avoid propagation of thrombus in vessels distal to the occlusion. In multiple-injury patients, especially those with central nervous system trauma, heparin is inappropriate. The initial steps in the surgical management of vascular injuries is to obtain proximal and distal control of the injured vessel. This is most easily accomplished through uninjured areas adjacent to the injury using incisions normally employed for elective exposure of these vessels. Direct approach to the site of injury is fraught with the hazards of severe hemorrhage and iatrogenic trauma to the vessel itself or adjacent nerves. The management of the arterial injury is determined by the extent of injury. In a repair of more extensive arterial injuries, reversed saphenous vein from an uninjured lower extremity is the first choice for an interposition graft. The repair of concomitant venous injuries is a controversial injury. Proximal extremity veins and the great veins are repaired whenever technically possible to avoid the sequela of venous occlusion. Venous repair should not be attempted, in a hemodynamically unstable patient; rather, ligation should be performed to expedite the operation.