Assessment of proximity of a wound to major vascular structures as an indication for arteriography

The use of angiography to evaluate penetrating extremity wounds with proximity to major vascular structures remains controversial. Arteriography in the asymptomatic patient with a penetrating extremity wound is reported to identify arterial injuries in 6% to 21% of patients; however, some injuries may have little clinical importance. This study attempted to determine the value of proximity as an indication for angiography. Five hundred seven asymptomatic patients with 534 penetrating extremity injuries underwent arteriography due to proximity to major vascular structures. Thirty-six arteriograms (6.7%) were positive. Seven patients did not undergo operative exploration, 19 patients (3.6%) had arteriograms, and ten (1.9%) had false-positive arteriograms. The remaining 498 patients had true-negative examination results. Arteriography was associated with 13 complications (2.6%). Proved vascular injury in the clinically asymptomatic patients in our series was extremely low (3.6%). These data make it difficult to justify arteriography due to proximity of injury to major vascular structures. However, it is difficult to abandon exclusion arteriography based on these retrospective data. These observations do suggest that better criteria to define proximity need to be identified.