Emergency center arteriography in the evaluation of suspected peripheral vascular injuries

From January 1982 through June 1983, 488 patients with suspected peripheral vascular injuries were examined with the use of 515 emergency center arteriograms performed by surgical residents via hand injection of contrast material using a single roentgenographic film. A total of 130 (25%) abnormal arteriograms resulted, including vascular spasm in nine instances and occlusion of noncritical arteries in 19 instances. One hundred two (20%) operations resulted from these abnormal emergency center arteriograms. A diminished pulse rate was the indication for performing 76 arteriograms, 52 (68%) of which were abnormal; however, only 43 patients from this group required surgery. Anatomic proximity to a major vessel was the sole indication for performing 352 arteriograms, 59 (17%) of which were abnormal. There was one false-normal arteriogram, one delayed development of an arteriovenous fistula, and four false-abnormal arteriograms. No complications of arteriography occurred during examination or at the time of clinic follow-up. Single-injection arteriography in the emergency center is a simple, sensitive, accurate, and cost-effective technique for the examination of patients with potential peripheral vascular injuries.