Comparison of computed tomography angiography and physical exam in the evaluation of arterial injury in extremity trauma

Warwick, Hunter; Cherches, Matthew F; Shaw, Chace; Toogood, Paul

doi:10.1016/j.injury.2021.04.057

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…The best diagnostic method for detecting vascular injuries was under debate in the literature. It is suggested that only patients with abnormal pulses or ABI undergo CTA in patients with knee dislocation [8], in contrast to some studies that recommended routine angiography for all patients [9]. Due to the difficulty of establishing the natural history of minor injuries resulting in healing or occlusion, we agree the "liberal use of angiography" for knee dislocation injuries [10].…”

Section: Discussionmentioning

confidence: 95%

Delayed diagnosis of popliteal artery injury after traumatic knee dislocation in Korea: a case report

et al. 2023

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The popliteal artery damage is present to range from 1.6% to 64% of patients with knee dislocation, and it is crucial to evaluate vascular damage even if there are no prominent ischemic changes in the distal area. The injury of the popliteal artery by high-energy forces around the knee caused by a fall or traffic accident is a potentially limb-threatening complication in traumatic knee dislocation. The popliteal artery injury by blunt trauma has a high risk of limb amputation because the initial symptoms can show normal vascular circulation without urgent ischemia or obvious vascular injury signs. Since the collateral branches can delay the symptoms of decisive ischemia or pulseless extremity, the vascular damage is a major cause of limb amputation. In the present study, we describe a rare case of delayed diagnosis of popliteal artery injury after traumatic knee dislocation, requiring urgent limb revascularization surgery. After revascularization of the occluded popliteal artery, graft interposition was performed, and successful restoration was confirmed. This case illustrates that, even if ankle-brachial index >0.9 or equal pedal pulse to the uninjured extremity, serial vascular evaluation is required if there are soft signs such as diminished pulses, neurologic signs, or high-energy damage such as multiple ligament ruptures since delayed diagnosis of artery injury can be the major cause of limb amputation. The clinicians need to regard high-energy trauma such as multiple ligament rupture around the knee as a hard sign, and immediate computed tomography angiography can be helpful for accurate diagnosis and treatment.

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Section: Discussionmentioning

confidence: 95%

Delayed diagnosis of popliteal artery injury after traumatic knee dislocation in Korea: a case report

et al. 2023

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“…One hundred percent of the patients recovered pulses at the end of the surgery until their discharge, having no amputations. Computed tomography angiography has a sensitivity and specificity close to 100% and is useful when physical examination alone cannot definitively diagnose or rule out vascular injury or when there are multiple lesions 4,7 .…”

Section: Resultsmentioning

confidence: 99%

“…In the presence of hard signs of arterial injury such as pulsatile hematoma, expanding hematoma, active bleeding, audible bruit, thrill, and signs of arterial occlusion (absence of pulses, pallor, paresthesia, pain, paralysis, and poikilothermia), urgent surgical intervention is required 7,8 . The evaluation should be complemented with a brachio-brachial index, so a difference > 10 mmHg could suggest vascular injury 2,7,8 . Doppler ultrasound of the upper extremity has a sensitivity of 99% and a specificity of 98%.…”

Section: Discussionmentioning

confidence: 99%

Brachial artery injury in a referral center in central Mexico

Piña-Avilés,

Lacayo-Valenzuela,

Rivera-Castañeda

et al. 2023

HGMX

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Introduction: Brachial artery lesions are rare, even in high concentration trauma centers and despite having good technical success, they can have significant functional limitations due to being associated with nerve lesions, that is why we decided to describe our experience in the management of lesions of brachial artery. Material and methods: Review of clinical records of patients with brachial artery injury treated by the vascular surgery service at the General Hospital of Mexico from January 1, 2013 to May 30, 2022 was performed. Characteristics of the lesions, time elapsed from lesion to revascularization, type of surgical treatment, and postoperative results. Results: 16 lesions were treated. 100% with late referral (more than 6 hours after the injury). There were 9 (56.25%) complete sections, 4 (25%) partial section, 2 (12.5%) thrombosis, and 1 (6.25%) pseudoaneurysm. 100% of the lesions were distal to the deep brachial branch. 8 (50%) had associated venous injury, 6 (37.5%) nerve injury (median nerve in 100%). The treatment was 3 (18.75%) simple closure by partial section, 3 (18.75%) end-to-end anastomosis, 8 (50%) autologous bypass (5 with reverse vein of the ipsilateral arm and 3 with great saphenous vein) and 2 (12.5 %) thrombectomy. Technical success in 100% and 0% amputation. Conclusion: Due to the important collaterality of the brachial artery, the percentage of amputation is very low and, despite late care, revascularization should be offered to improve the functional prognosis of the limb.

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Vascular Injury of Penetrating Trauma of the Extremities

Simsek,

Gur

2024

Emergency Medicine International

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Background: Physical examination and computed tomography angiography (CTA) are used for diagnosing arterial injury in extremity trauma. In recent years, CTA has been overused to obtain more objective data. Our study aimed to investigate the effect of using CTA for the management of patients with extremity penetrating injuries, specifically in cases where vascular injury was not detected during initial examination.Methods: This retrospective study included patients with penetrating trauma who underwent CTA of the extremities. The demographic data, mechanism of injury, the side of injury, initial vascular exam (normal, soft signs, and hard signs), radiological results, and any orthopedic and vascular intervention performed were recorded. The χ2 test was used for independent variables. A significance level of p < 0.05 was used. We compared the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for physical exam and CTA for identifying arterial injury requiring intervention.Results: Of the 252 patients included in the study, 29 (21.5%) had abnormal vascular physical examination while 26 (10.3%) had an abnormal CTA. The NPV of the hard sign for identifying vascular injury was 95.4%, while the sensitivity was 57.7%, specificity was 100%, and PPV was 100%. The NPV of routine physical examination to determine the requirement for vascular intervention was 100%. The sensitivity and PPV of the soft sign in determining the need for vascular intervention were 65.4% and 77.3%, respectively.Conclusion: Vascular injury was present in all cases that had positive hard signs. CTA imaging and vascular intervention are not necessary in patients who exhibit no hard and/or soft indicators during a thorough physical examination.

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Comparison of computed tomography angiography and physical exam in the evaluation of arterial injury in extremity trauma

Cited by 3 publications

References 16 publications

Delayed diagnosis of popliteal artery injury after traumatic knee dislocation in Korea: a case report

Delayed diagnosis of popliteal artery injury after traumatic knee dislocation in Korea: a case report

Brachial artery injury in a referral center in central Mexico

Vascular Injury of Penetrating Trauma of the Extremities

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