A Reassessment of the Role of Arteriography in Penetrating Proximity Extremity Trauma

Frykberg, Eric R.; Crump, John M.; Vines, Frederick S.; McLellan, Garey L.; Dennis, James W.; Brunner, Richard G.; Alexander, Raymond H.

doi:10.1097/00005373-198908000-00001

Cited by 102 publications

(42 citation statements)

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“…The authors of these reports state that clinically occult vascular injury takes a benign natural course. Supporting evidence is reported by Frykberg et al [19] based on a similar study on penetrating injury to the extremities. Other authors, however, support the routine use of angiography in patients with a gunshot to the neck [12,13].…”

Section: Discussionsupporting

confidence: 72%

Is Routine Angiography Necessary in Patients with a Gunshot Wound to the Neck? A Retrospective Analysis

Deurzen

Verleisdonk

2002

Eur J Trauma

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Aim: The aim of this study was to investigate the implication of clinical findings of vascular injury and routinely employing angiography in patients who sustained a gunshot to the neck. Patients and Methods: We retrospectively studied the demographics, bullet tract, clinical findings, diagnostic investigations, methods of treatment, outcome, and time in hospital of 70 patients who sustained a gunshot to the neck and who all underwent angiography. Results: In nine cases angiography revealed lesions to the common carotid artery (four patients), internal carotid artery (three patients), vertebral artery (one patient), and lingual artery (one patient). Physical examination had already indicated vascular damage in seven of these patients with findings such as expanding hematoma (four patients), absent carotid pulsations (two patients), bruit (one patient), and hypovolemic shock (one patient). Subsequently, these seven patients were treated operatively by performing elective neck exploration. Of these seven patients who underwent surgical repair, vascular damage was already suspected based on physical examination. The two patients with injury on angiography without clinical evidence did not deteriorate on conservative management. Conclusions: Careful clinical assessment proves to be a useful instrument in determining the necessity of surgical exploration. In our experience in 70 patients, the results of angiography did not alter the management of the patients who sustained a gunshot to the neck.Our results on conservative management with selective angiography indicate that morbidity and mortality of unnecessary neck explorations are avoided without increased risk.

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Section: Discussionsupporting

confidence: 72%

Is Routine Angiography Necessary in Patients with a Gunshot Wound to the Neck? A Retrospective Analysis

Deurzen

Verleisdonk

2002

Eur J Trauma

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“…Comprehensive investigation into the positive predictive value of the "hard signs" of vascular injury by Frykberg's group has been instrumental in decreasing the need for routine invasive imaging in the injured lower extremity. [10][11][12][13][14][15][16] In addition to this, although injuries "occult" to the initial physical examination may occur, this group has documented, with stringent long-term follow up, that the natural history of these injuries is benign in the majority of patients. For those that do have a clinically significant missed injury, there is no adverse sequelae associated with the delay in diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Multi-slice CT Angiography for Arterial Evaluation in the Injured Lower Extremity

Inaba

Potzman

Múnera

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

129

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“…24 In contrast, recent authors have advocated selective angiography based on serial physical examina- tions. 14,15,20,23 Frykberg et al 35 found that routine angiography performed for proximity in asymptomatic penetrating extremity wounds yielded a medical cost of $66,000 per vascular injury requiring surgery. Table 5 lists several series that evaluated the need for routine angiography.…”

Section: Discussionmentioning

confidence: 99%

Management of Arterial and Venous Injuries in the Dislocated Knee

Armstrong

Franklin

2001

Sports Medicine and Arthroscopy Review

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Vascular injury is present in 30% of dislocated knees and continues to account for significant morbidity. Popliteal artery injury results in a disproportionate number of amputations compared with other extremity arterial injuries. The vascular anatomy and mechanism of injury are reviewed here. A high index of suspicion and systematic evaluation for vascular injury associated with knee dislocation are required to ensure correct diagnosis. Early recognition of vascular injury, prompt restoration of flow, and use of proven adjuncts provides the optimal possibility of limb salvage of popliteal artery injuries associated with knee dislocations.

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A Reassessment of the Role of Arteriography in Penetrating Proximity Extremity Trauma

Cited by 102 publications

References 0 publications

Is Routine Angiography Necessary in Patients with a Gunshot Wound to the Neck? A Retrospective Analysis

Is Routine Angiography Necessary in Patients with a Gunshot Wound to the Neck? A Retrospective Analysis

Multi-slice CT Angiography for Arterial Evaluation in the Injured Lower Extremity

Management of Arterial and Venous Injuries in the Dislocated Knee

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