Rethinking protocolized completion angiography following extremity vascular trauma: A prospective observational
Grace M Niziolek1, Jane Keating, Joanelle Bailey
1From the Division of Trauma, Critical Care, and Emergency General Surgery, Department of Surgery (G.M.N., N.J.K., M.J.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Surgery (J.K.), Hartford Hospital, New Haven, Connecticut; Department of Surgery (J.B.), Rutgers New Jersey Medical School, Newark, New Jersey; Department of Surgery (N.J.K.), Emory University, Atlanta, Georgia; Salem Health Surgical Clinic - General Surgery (A.M.M.), Salem Hospital, Salem, Oregon; Department of Surgery (D.J.S.), University of Florida College of Medicine - Jacksonville, Jacksonville, Florida; Department of Surgery (A.L., M.A.V.), University of Rochester, Rochester, New York; Department of Surgery (Z.M.), Temple University, Philadelphia, Pennsylvania; Department of Surgery (S.A.M.), University of New Mexico, Albuquerque, New Mexico; Department of Surgery (M.C.S.), Vanderbilt University, Nashville, Tennessee; School of Medicine (A.L.), University of California - Irvine, Irvine, California; and Department of Surgery (K.M.S.), Yale University, New Haven, Connecticut.
Background:
Completion angiography (CA) is commonly used following repair of extremity vascular injury and is recommended by the Eastern Association for the Surgery of Trauma practice management guidelines for extremity trauma. However, it remains unclear which patients benefit from CA because only level 3 evidence exists.
Methods:
This prospective observational multicenter (18LI, 2LII) analysis included patients 15 years or older with extremity vascular injuries requiring operative management. Clinical variables and outcomes were analyzed with respect to with our primary study endpoint, which is need for secondary vascular intervention.
Results:
Of 438 patients, 296 patients required arterial repair, and 90 patients (30.4%) underwent CA following arterial repair. Institutional protocol (70.9%) was cited as the most common reason to perform CA compared with concern for inadequate repair (29.1%). No patients required a redo extremity vascular surgery if a CA was performed per institutional protocol; however, 26.7% required redo vascular surgery if the CA was performed because of a concern for inadequate repair. No differences were observed in hospital mortality, length of stay, extremity ischemia, or need for amputation between those who did and did not undergo CA.
Conclusion:
Completion angiogram following major extremity injury should be considered in a case-by-case basis. Limiting completion angiograms to those patients with concern for an inadequate vascular repair may limit unnecessary surgery and morbidity.
Level Of Evidence:
Therapeutic/Care Management; Level III.
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