Angiographic findings and need for amputation in high tension electrical injuries

Because it is difficult to estimate the extent of deep tissue injury clinically, angiography was carried out in 28 patients with signs of damage from current flow through the body. Eight of the arteriograms showed normal extremities, 6 showed changes of small arteries, and 38 showed injury to the main arteries. In the latter group there were 24 total arterial occlusions, narrow irregular lumens in 10, and 4 had occlusion and distal refilling. Changes in the main arteries were most often seen near major joints where the internal body resistance as well as the density of the current are higher. Injury to the main arteries resulted in severe neuromuscular damage or amputation of the limb, whereas injury to small arteries resulted in little functional deficit. Of the 25 amputations 19 were at the level of the arterial occlusion. Spasmolytic drugs did not increase filling. We conclude that early angiography is valuable for the detection of deep injury and often indicates the level of adequate amputation or the need for immediate exploration. In some patients it indicates the necessity for arterial reconstruction.