[Indications for arteriography in penetrating wounds of the lower limbs]

One hundred arteriographies were performed in emergency in 87 patients with penetrating trauma of the lower limbs caused by high- or medium-velocity projectiles (bullet or shell fragment). Thirteen patients had bilateral wounds. In 79 cases, the arteriogram was abnormal and led to surgical exploration. In 76 cases, an arterial lesion was found and treated (positive predictive value = 76/79 = 96%). In three cases, no arterial lesion was detected (3 false-positive findings). Among the 21 patients with normal arteriograms, 10 had surgical exploration because of clinical suspicion. An arterial lesion was found in 2 cases (2 false-negative findings). In the other 11 cases, the clinical and Doppler sonographic observations were normal (negative predictive value = 19/21 = 90%). The sensitivity rate was 97%, specificity 86% and accuracy 95%. In 8 cases, arteriography led to modifying the surgical procedure. These results show that preoperative arteriography, performed as an emergent examination in hemodynamically stable patients, allows avoiding surgery in some cases, and modifying the procedure in others.