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Una presentación atípica de la lesión vascular en el trauma de las extremidades más allá de las directrices actuales
Taylor Broudy1, Logan Gonsalves2, Jonathan King2
1Department of Surgery, Howard University College of Medicine, Washington, D.C., USA.
Cureus
|September 4, 2025
Resumen
La angiografía por tomografía computarizada (CTA) puede detectar lesiones vasculares que no se encuentran en las directrices actuales. Un estudio de caso muestra que la CTA identificó una fístula arteriovenosa femoral en un paciente traumatizado con un índice tobillo-braquial normal, enfatizando el juicio clínico en el diagnóstico.
Área de la Ciencia:
- Cirugía de traumas
- Imágenes vasculares
- Radiología de diagnóstico
Sus antecedentes:
- La angiografía por tomografía computarizada (CTA) es crucial para el diagnóstico de lesiones vasculares en pacientes con trauma.
- Las directrices actuales de la Asociación Oriental para la Cirugía de Trauma (EAST) recomiendan CTA para hallazgos físicos anormales o índice tobillo-braquial (ABI) ≤ 0,9.
Objetivo del estudio:
- Para resaltar las limitaciones de las directrices actuales de EAST para la CTA en trauma.
- Para enfatizar la importancia del juicio clínico en el diagnóstico de lesiones vasculares sutiles.
Principales métodos:
- Informe de caso de un hombre de 32 años con una herida de bala en el muslo.
- Utilizado CTA a pesar de un ABI normal y la ausencia de hallazgos físicos evidentes.
- Revisó las directrices de EAST y la toma de decisiones clínicas.
Principales resultados:
- CTA reveló una fístula arteriovenosa femoral traumática, que no fue sospechoso basado en el ABI.
- El paciente se sometió con éxito a la reparación endovascular de la fístula.
- El caso demuestra un escenario en el que los criterios de imagen establecidos eran insuficientes.
Conclusiones:
- Las directrices EAST existentes para la CTA pueden no abarcar todas las lesiones vasculares clínicamente significativas.
- Los signos físicos sutiles, un alto índice de sospecha y el juicio clínico son vitales para el diagnóstico y tratamiento oportunos del trauma vascular.
- El CTA sigue siendo una herramienta indispensable, incluso cuando no se cumplen los criterios estándar.
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