In infrahepatic interruption of the inferior vena cava (IVC), continuation is usually through the azygos or hemiazygos systems (Chuang et al, 1974; Smathers et al, 1982; Mayo et al, 1983). Recently, Bercoff et al (1985) described the first case of portal continuation. We observed such an anomaly in a patient who had a single left-sided IVC with hemiazygos-azygos continuation, and a shunt between the portal and hepatic systems. To our knowledge nosuch complex anomaly has yet been reported.
One hundred emergency arteriographies (EA) were performed in 87 patients with lower limb trauma due to high-velocity missiles. Thirteen patients had bilateral injuries. In 79 cases, EA findings were positive and led to emergency surgery. In 76 cases an arterial injury was found and treated, a positive predictive value of 96% (76/79). In the other 3 cases, no arterial lesion was found (3 false positives). Among the 21 patients with normal findings from angiography, 10 had surgical exploration because of high clinical suspicion of vascular injury. Arterial injury was found in 2 cases (2 false negatives). In 8 patients, arteriography modified the surgical procedure. In the 11 remaining patients, clinical and echo Doppler follow-up results were normal, a negative predictive value of 90% (19/21). Sensitivity was 97%, specificity 86%, and accuracy 95%. These data show that arteriography in stable patients is a safe and accurate procedure. It permits avoidance of unnecessary surgical exploration in selected patients and helps modify the surgical procedure.
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