Role of angiography in cervicothoracic trauma

The role of angiography in cervicothoracic trauma is controversial. Since 1967 the policy at San Francisco General Hospital has been to use liberal indications for angiography in hemodynamically stable patients with either penetrating or blunt cervicothoracic trauma. The 304 patients in Group 1 had emergency angiographic evaluation: 102 had penetrating cervical wounds: 202 had thoracic injuries-71 penetrating and 131 blunt trauma. During the same time period, 72 patients (Group II) had cervical or thoracic vascular injuries and underwent operative treatment without preoperative angiography. Sixty-six patients in Group 1 had significant vascular injury. Thirty patients with penetrating cervical injury had 38 vascular lesions. Thirty-six patients with gunshot or blunt chest trauma had 43 vascular lesions. Group II patients had two main indications for operation: exanguinating hemorrhage (45 patients) or suspected vascular injury, usually associated with hemorrhage (27 patients). Angiographic results were useful whether abnormal or normal. In cases with adnormal findings operative treatment was specific and improper incisions were avoided. In cases with normal angiographic results, clarification of the vascular status avoided unnecessary operations and permitted concentration of therapeutic effort upon the main clinical problems of the patients.