Digital venous angiography. A prospective evaluation in peripheral arterial trauma

Digital venous angiography (DVA), a new radiographic technique, was prospectively compared to conventional intra-arterial angiography (CA) in a group of 153 patients with trauma and suspected peripheral arterial injury ( PAI ). Criteria for entry included: large hematoma, proximity to a major vessel, shotgun wounds, blunt injury of the extremities, and fractures or dislocations of areas with high risk of arterial injury. Patients with unequivocal clinical evidence of PAI were excluded. Study patients had both DVA and CA. Sixteen injuries were diagnosed: lacerations (9), transection (1), AV fistulae (2), thromboses (2) and minute intimal flaps (2). All patients with abnormal studies were surgically explored; there were no false-positives. There were no known false-negatives with CA. The intimal flaps were not recognized initially on DVA and their clinical significance is questioned. DVA, compared to CA in PAI , had decreased patient discomfort, cost, and morbidity. It has the potential for study of multiple areas of the body from a single I.V. catheter. DVA can probably replace CA for civilian penetrating wounds. CA may remain the standard for blunt and high velocity injuries.