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Digital subtraction angiography in extremity trauma.

P C Goodman, R B Jeffrey, M Brant-Zawadzki

|October 1, 1984

Summary

Digital subtraction angiography (DSA) offers a rapid and effective method for diagnosing vascular injuries in trauma patients. This imaging technique accurately identifies conditions like arteriovenous fistulae and pseudoaneurysms, improving patient care.

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Area of Science:

Radiology
Vascular Imaging
Trauma Care

Background:

Blunt and penetrating trauma frequently cause vascular injuries, necessitating prompt and accurate diagnosis.
Critically ill patients with immobility due to fractures present challenges for traditional imaging methods.
Digital subtraction angiography (DSA) is a potential tool for evaluating these injuries.

Purpose of the Study:

To assess the impact and diagnostic utility of digital subtraction angiography (DSA) in the work-up of extremity trauma.
To evaluate the speed, accuracy, and efficiency of DSA in identifying vascular injuries in trauma patients.

Main Methods:

Retrospective review of digital subtraction angiograms from 50 consecutive patients with extremity trauma.
Analysis of image quality, diagnostic confidence, and confirmation of findings through surgical or clinical follow-up.
Assessment of procedure time, contrast material usage, patient discomfort, and cost-effectiveness.

Main Results:

DSA provided confident diagnoses in 44 out of 50 cases, with accuracy confirmed by follow-up.
Minor discrepancies (one false-positive, three false-negative for small muscle bleeders) were found but deemed clinically insignificant.
DSA demonstrated reductions in procedure time, contrast volume, patient discomfort, and film costs.

Conclusions:

Digital subtraction angiography (DSA) is a valuable tool for the rapid and accurate diagnosis of vascular injuries in extremity trauma.
DSA offers advantages in efficiency and resource utilization compared to other methods, especially for immobilized patients.
The limited field size of the image intensifier remains a notable disadvantage of DSA.

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