Stab wounds to the extremities: indications for angiography

To ascertain the sensitivity of physical examination with respect to significant arterial injury, the angiographic findings of 61 stab wounds to the extremities were correlated with specific physical findings. In 25 injuries there were physical findings of major injury, including one or more of the following: pulse deficit, active bleeding or expanding hematoma, bruit or murmur, neurologic deficit, or hypotension. Of these 25 injuries, angiographic examination revealed significant vascular damage in 11. In 36 injuries physical findings indicated minor injury, with proximity to major vessels or nonexpanding hematoma being the only indication for arteriography. None of these patients had significant vascular injuries. Physical examination was found to be 100% sensitive in screening for significant vascular injuries. These results indicate that arteriography is unwarranted in stab wounds to the extremities if the only indications are proximity to major vessels or nonexpanding hematoma.