Vascular proximity: is it a valid indication for arteriography in asymptomatic patients?

The role of arteriography in asymptomatic patients with penetrating extremity wounds in proximity to major vessels is controversial. This prospective study was designed to evaluate a precise definition of proximity, determine the incidence of positive arteriograms, and correlate angiographic interpretation with operative findings. Proximity was defined as any wound located within 1 cm of a major vessel. Excluded were patients with a pulse deficit, bruit, thrill, history of arterial hemorrhage, expanding hematoma, nerve deficit, fracture, or significant soft-tissue injury. One hundred sixty arteriograms were performed in 146 patients. One hundred forty-three (89.4%) were true-negatives. Seventeen (10.6%) were suggestive of injury. These included seven (4.4%) true-positive arteriograms, six (3.8%) false-positive studies, and four (2.5%) positive arteriograms in patients who were not operated upon. The angiographic report correlated with operative findings in five (38.5%) of 13 patients. These data confirm the low incidence (4.4%) of vascular injury in asymptomatic patients. The use of extremity angiography when proximity is the sole indication in an asymptomatic patient with a normal vascular examination must be questioned.