Role of routine arteriography in blunt lower-extremity trauma

During an 18-month period, 53 patients with unilateral blunt lower-extremity trauma were entered into a prospective study designed to determine how often clinically occult arterial injuries are identified by routine arteriography, and how often these injuries are of sufficient magnitude to warrant therapeutic intervention. Patients underwent diagnostic arteriography if one or more of the following abnormal clinical findings were present: distal pulse deficit, nerve deficit, soft-tissue loss, decreased capillary refill, bruit, or a history of hemorrhage or hypotension. In the absence of these findings, arteriography was performed for significant orthopedic injuries, i.e., knee dislocations or complex long-bone fractures. In 31 patients (58%), arteriography was performed because 1 or more abnormal clinical findings were present and 12 arterial injuries were identified, 4 requiring arterial repair. The presence of a knee dislocation or complex long-bone fracture was the only indication for arteriography in 22 patients (42%) and 3 arterial injuries were identified, none requiring operative intervention. For all patients, two variables, pulse deficit and delayed capillary refill, strongly correlated (p less than 0.05) with arteriographic demonstration of an arterial injury. In the absence of these findings, routine diagnostic arteriography will have a low diagnostic yield and will rarely identify a vascular injury in a major artery that will require operative repair. Arteriography should be selectively performed and guided by examination and noninvasive Doppler indices.