Blunt trauma to the thoracic outlet and angiography

When major injuries occur to the thoracic outlet, common practice is to obtain an arteriogram without other clinical evidence of vascular injury, because of the purported high association of thoracic outlet trauma and vascular injuries, including ruptured aortae. In order to evaluate this association, a review was undertaken of all patients admitted to a major hospital over 5.5 years who underwent angiography or other evaluative measures as a result of their thoracic outlet trauma. There were no great vessel or aortic injuries without overt clinical criteria. Angiography for aortic and great vessel injury is unnecessary unless there is a widened mediastinum or other overt clinical indications of vascular injury. Judicious use or avoidance of angiography is therefore encouraged for multiple reasons.