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

Inaba, Kenji; Potzman, Jennifer; Múnera, Felipe; McKenney, Mark; Munoz, Rogelio; Rivas, Luis A.; Dunham, Michael; DuBose, Joseph J.

doi:10.1097/01.ta.0000204150.78156.a9

Cited by 129 publications

(71 citation statements)

References 31 publications

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“…With a sensitivity of 99%-100% and specificity of 87%-100%, CT angiography (CTA) has replaced conventional angiography in most cases. [15][16][17] While duplex ultrasound is a diagnostic alternative with similar sensitivity and specificity, studies have often found diagnostic accuracy to be user dependent. 14,18 Timing of presentation after injury plays a critical role in a patients' outcome.…”

Section: Discussionmentioning

confidence: 99%

Bullet to the femoral head

Akella¹,

Murthy²,

Bell³

et al. 2016

OAS

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Section: Discussionmentioning

confidence: 99%

Bullet to the femoral head

Akella¹,

Murthy²,

Bell³

et al. 2016

OAS

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“…Other options such as duplex ultrasonography (100% sensitivity and 97% specificity for clinically significant arterial injury) or CT angiography (95-100% sensitivity and 97-98% specificity) have also been described. [21][22][23] Even though, serial neurovascular examinations have shown equal sensitivity and specificity compared to obtaining a formal angiographic study, we have adopted a policy that ensures angiographic examination of all knee dislocations. Despite these efforts our amputation rate remains at 25% (seven of 28 patients) of diagnosed vascular injuries.…”

Section: Discussionmentioning

confidence: 99%

High rate of popliteal artery injuries and limb loss in 96 knee dislocations

Held¹,

Laubscher²,

Bormann³

et al. 2016

SA orthop. j.

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Background: Knee dislocations are reported to have an incidence of popliteal artery injuries between 7% and 64%. The purpose of this study was to determine the incidence of injuries to the popliteal artery as well as early limb loss in knee dislocations at a level-1 trauma hospital in South Africa. Methods:Twenty-eight patients with popliteal artery injuries were selected from a prospectively collected database of 96 patients with acute knee dislocations. The incidence of vascular injuries, compartment syndromes and limb loss was determined retrospectively. Results:Of 96 knee dislocations 28 had a popliteal artery injury (29.1%). Seven of 28 patients with popliteal artery injuries needed an amputation. Of the 28 patients, ten were documented as a threatened limb. Five of these ten patients (50%) needed an amputation. The documented median delay to revascularisation of patients who presented with threatened limbs was 10 hours. Conclusion:Overall, one-third of knee dislocations presented with a vascular injury. The prevalence of amputations in knee dislocations with associated popliteal artery injuries was 25% and increased to more than 50% in patients who presented with a threatened limb. A recent study has described popliteal artery injury rates as low as 1.6% with only 0.1% of patients needing an amputation.9 Indisputably, each multidirectional knee injury with an adequate history of trauma and presentation should be regarded as a knee dislocation until proven otherwise. 1The mechanism of injury in knee dislocations can range from high energy injuries due to road accidents and falls from a height to low energy injuries such as sports injuries and even ultra-low-velocity injuries such as simple falls, especially in obese patients. [10][11][12][13] The energy level of the injury can affect the injury pattern itself, which varies from ligamentous disruption only, to knee dislocations with severe soft tissue damage, compartment syndrome, open wounds and fractures, all of which are risk factors for adverse limb outcomes. 14,15 In its most severe presentation a knee dislocation can be associated with popliteal artery injuries resulting in a threatened limb and subsequent limb loss if not treated urgently. The specific anatomy of the popliteal artery makes it susceptible to damage during trauma. It is fixed to the distal femur in the adductor canal, and is tethered distally under the soleus muscle and inbetween the two heads of the gastrocnemius muscles. With its tenuous collateral supply, the arterial flow is very rarely sufficient to guarantee adequate distal perfusion to the limb during a complete disruption of the popliteal artery. The purpose of this study was to determine the frequency of popliteal artery injuries in knee dislocations and evaluate the incidence of early limb loss. MethodsTwenty-eight of 96 consecutive knee dislocations admitted to the trauma unit of a tertiary care hospital in South Africa over a period of 12 years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)...

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“…5,6 Additionally, an increasing number of emergency physicians prefer MDCT over catheter-based angiography.…”

Section: Discussionmentioning

confidence: 99%

Sonographic Detection of Pseudoaneurysm in Vascular Injury in Emergency Department = الكشف بالموجات فوق الصوتية عن أم دم كاذبة في إصابات الأوعية الدموية في قسم الطوارئ

Chien¹,

Su²,

Chen³

et al. 2013

SQUMJ

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abstract:A 31-year-old man suffered from a stab wound to the lower extremity. The patient had a hard sign of a vascular injury (a diminished distal pulse) and therefore probably should have undergone operative repair, but refused. One week later, he returned to our emergency department with a painful right thigh swelling. Bedside sonography was used to detect a pseudoaneurysm. Emergency sonography is a fast, non-invasive, and rapid decision-making approach in emergency practice.

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

Abstract: MCTA is a sensitive and specific non-invasive imaging modality for arterial evaluation in the injured lower extremity that may replace catheter-based angiography in most patients.

Cited by 129 publications

References 31 publications

Bullet to the femoral head

Bullet to the femoral head

High rate of popliteal artery injuries and limb loss in 96 knee dislocations

Sonographic Detection of Pseudoaneurysm in Vascular Injury in Emergency Department = الكشف بالموجات فوق الصوتية عن أم دم كاذبة في إصابات الأوعية الدموية في قسم الطوارئ

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