Utility of arteriography in penetrating extremity injuries

The role of contrast arteriography in the management of patients with penetrating injuries of the extremities is a subject of active debate. To examine our experience, the charts of patients with penetrating injuries of the extremities were retrospectively reviewed. Data from 82 consecutive patients with 98 wounds over the 5-year period from January 1984 to December 1988 were reviewed. Sixty-five arteriograms were obtained to investigate 98 wounds: 8 to localize a clinically apparent wound and 57 because of proximity of the wound or the trajectory of the injuring agent to a major neurovascular bundle. Of the 57 arteriograms obtained because of proximity, 11 identified a vascular injury (19%). Six of these wounds required vascular repair; five patients were treated expectantly. Six of the eight arteriograms obtained for clinical indications were positive (75%), while two were negative (25%). There were no amputations in the study, and all vascular reconstructions were considered successful by clinical and vascular laboratory criteria. One patient died of thoracic injuries; otherwise, all patients were discharged in good condition. Long-term follow-up was not available. In summary, 19% of arteriograms done because of proximity criteria alone identified a clinically occult vascular injury. While only 11% of all proximity arteriograms revealed injuries requiring surgical repair, this rate of significant injury warrants aggressive use of proximity arteriography in a patient population that is prone to poor follow-up.