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Angiography in the evaluation of proximal arterial injury
1Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Insights
Angiography is a safe and accurate tool for diagnosing peripheral arterial trauma. However, it may be overused in patients with proximal injuries lacking other clinical signs.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Trauma Care
Background:
- Peripheral arterial trauma diagnosis can be challenging.
- The role of angiography in evaluating these injuries remains debated.
Purpose of the Study:
- To assess the safety and accuracy of angiography in diagnosing peripheral arterial trauma.
- To determine the appropriate indications for angiography in trauma patients.
Main Methods:
- Retrospective review of 78 angiographic evaluations in 70 trauma patients.
- Analysis of injury types, locations, and indications for angiography.
- Correlation of angiographic findings with clinical signs.
Main Results:
- Angiography identified arterial abnormalities in 11 of 78 injuries.
- No false-positive arteriograms were reported.
- Abnormalities were most frequently associated with abnormal pulse, bleeding, expanding hematoma, or neurologic deficits.
Conclusions:
- Exclusion angiography is a safe and accurate diagnostic method for peripheral arterial trauma.
- Angiography may be overutilized in patients with proximal injuries without other specific clinical indicators.
Abstract:
The appropriate use of angiography in the evaluation of possible peripheral arterial trauma is still controversial. At the Johns Hopkins Hospital during the past two years, 78 traumatic injuries were evaluated angiographically in 70 consecutive patients, including 63 men and seven women, ranging in age from five to 78 years (mean of 26.5 years). There were 63 gunshot, five stab, three shotgun and seven blunt injuries. Fifty-two involved the lower extremity; 21, the upper extremity; two, the buttock; two, the neck, and one, the pelvic region. Indications for study included proximal injury in 59, abnormal pulse examination in six, expanding hematoma in four, neurologic abnormality in six and bleeding and hypotension in three. Arterial abnormalities were documented in 11 of these injuries, including five of injuries with an abnormal pulse, two with bleeding and hypotension, two with an expanding hematoma, one with a neurologic deficit and one of proximal injuries. There were no false-positive arteriograms. The results of this study demonstrate that exclusion angiography is safe and accurate, but probably overused in the patient with proximal injury in the absence of other clinical signs.