Penetrating extremity trauma: Identification of patients at high-risk requiring arteriography

Abstract

Indications for arteriography in patients with penetrating trauma to the extremities remain controversial. Some clinicians have recommended universal use of arteriography, whereas others prefer to rely on physical findings alone. To better define our indications for contrast studies, we reviewed clinical data on 306 patients (349 extremities) with penetrating trauma who were admitted during a prior 2-year period (1985 to 1987). Injuries were caused by stab wounds in 50 (14.3%) extremities and by gunshot wounds in 299 (85.7%) extremities. Twenty-seven of the 50 stab wounds (54%) required urgent exploration based on physical findings, whereas 23 underwent arteriography. None of these studies showed unsuspected arterial injury. Twenty-nine of 299 gunshot wounds (9.7%) underwent mandatory exploration, and arteriograms were performed on 270 extremities; findings in 30 studies (11.1%) were positive for unsuspected arterial injuries. Gunshot wounds were categorized according to location and number of arteriograms with positive results. Arteriograms of lateral thigh and upper arm injuries resulted in no positive outcomes. Positive study results were recorded in 22.9% of calf injuries, 20% of forearm and antecubital injuries, 9.5% of popliteal fossa injuries, 9.0% of medial and posterior thigh injuries, and 8.3% of medial and posterior upper arm injuries. We recommend arteriography for penetrating injuries to these high-risk areas. However, clinical evaluation alone is accurate for identification of arterial trauma with lateral thigh or upper arm wounds and stab wounds to the extremities.

Missed profunda artery injuries in two patients with penetrating lower extremity trauma: A case report

“…Anderson et al recommends arteriograms in certain high risk patient populations, including patients with penetrating injuries to the posterior and medial thigh regions [2,3]. In their experience, 9% of penetrating injuries to this area were associated with arterial lesions [2].…”

“…The presence of penetrating trauma carries an occult vascular injury risk ranging from 6 to 28% [2,3,16,17]. Numerous diagnostic examinations are available to aid the clinician in reaching a diagnosis in patients suspected of having a vascular injury including arterial pressure index (API), Doppler ultrasonography, computed tomography arteriography (CTA), and direct exploration [4,13,14,18,20,22].…”

Coping With War Mass Casualties in a Hospital Under Fire: The Radiology Experience

“…After embolization, pseudoaneurysm and arteriovenous fistula are no longer seen. replacing conventional angiography for peripheral vascular diagnosis [9][10][11][12][13].…”

Diagnosing Traumatic Arterial Injury in the Extremities with CT Angiography: Pearls and Pitfalls

“…Conventional arteriography was developed in the 1970s, allowing for accurate diagnosis of arterial injury with a less invasive procedure than open surgical exploration of the vessels. It has an associated morbidity of 1%-2%, but the benefits of its high diagnostic accuracy and of early percutaneous intervention for selected types of arterial injury outweigh the risks of a missed diagnosis of acute arterial injury in the extremities (2,3,5).…”

“…According to the surgical and trauma literature, prompt repair of arterial injuries to the extremities improves outcome in terms of limb function and mortality related to blood loss (1)(2)(3)(4). Conventional arteriography was developed in the 1970s, allowing for accurate diagnosis of arterial injury with a less invasive procedure than open surgical exploration of the vessels.…”