Indications for angiography in extremity trauma

McCorkell, SJ; Harley, J. D.; Morishima, Manabu; Cummings, Douglas

doi:10.2214/ajr.145.6.1245

Cited by 60 publications

(13 citation statements)

References 1 publication

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“…36,37 This has been demonstrated for blunt as well as penetrating trauma. 38,39 Further, there are long-term data to support observation of patients with a normal neurovascular exam as well as patients with occult abnormalities seen at angiography including small pseudoaneurysms and nonocclusive intimal defects with intact and patent distal vessels. 37 A small percentage of patients may ultimately require surgery, but, in one report, all came to attention within 6 to 12 months with onset of hard signs of vascular injury, and none suffered limb morbidity or loss.…”

Section: Extremitiesmentioning

confidence: 98%

The Role of Interventional Radiology in Trauma

Gould

Vedantham²

2006

Semin intervent Radiol

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Since the development of angiography and transcatheter techniques, interventional radiology has played an important role in the management of trauma patients. The ability to treat life-threatening hemorrhage with transcatheter embolization has spared countless patients the morbidity of surgery. Advances in cross-sectional imaging and increases in understanding of which patients will best benefit from embolization promise to further refine the interventional radiologist's role. As the applications of transcatheter therapy broaden to include embolization of unstable patients with solid organ injuries and endovascular repair of major arterial injuries, the interventional radiologist must be increasingly prepared to provide prompt, efficient, and high-quality service.

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Section: Extremitiesmentioning

confidence: 98%

The Role of Interventional Radiology in Trauma

Gould

Vedantham²

2006

Semin intervent Radiol

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“…1,6,9,14,16,17 Primary surgical exploration of patients with proximity of a wound to major vascular structures has been advocated. 8,9 The role of emergency arteriography in these patients is not well defined. 5,7,[9][10][11][15][16][17] In our series emergency arteriography was performed in all stable patients who arrived at the ER with a penetrating wound proximate to a major vascular artery.…”

Section: Discussionmentioning

confidence: 99%

Emergency Arteriography in the Assessment of Penetrating Trauma to the Lower Limbs

Jebara¹,

Haddad

Ghossain

et al. 1991

Angiology

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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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“…Signs of arterial injury include loss of pulses in an extremity, expanding hematoma, thrill or bruit, active pulsatile bleeding, and neurologic deficit in the limb. Because there is a high correlation between these clinical findings and the presence of arterial injury, these "hard" signs warrant evaluation for arterial injury (1,3). "Soft" signs of arterial injury include a cool limb, change in color, nonexpanding hematoma, and nonpulsatile bleeding.…”

Section: Clinical Signsmentioning

confidence: 99%

“…According to the surgical and trauma literature, prompt repair of arterial injuries to the extremities improves outcome in terms of limb function and mortality related to blood loss (1)(2)(3)(4). Conventional arteriography was developed in the 1970s, allowing for accurate diagnosis of arterial injury with a less invasive procedure than open surgical exploration of the vessels.…”

Section: Introductionmentioning

confidence: 99%

“…Conventional arteriography was developed in the 1970s, allowing for accurate diagnosis of arterial injury with a less invasive procedure than open surgical exploration of the vessels. It has an associated morbidity of 1%-2%, but the benefits of its high diagnostic accuracy and of early percutaneous intervention for selected types of arterial injury outweigh the risks of a missed diagnosis of acute arterial injury in the extremities (2,3,5).…”

Section: Introductionmentioning

confidence: 99%

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Diagnosing Traumatic Arterial Injury in the Extremities with CT Angiography: Pearls and Pitfalls

Miller‐Thomas¹,

West²,

Cohen³

2005

RadioGraphics

153

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Computed tomographic (CT) angiography is a reliable and convenient imaging modality for diagnosing arterial injuries after blunt and penetrating trauma to the extremities. It is a noninvasive modality that could replace conventional arteriography as the initial diagnostic study for arterial injuries after trauma to the extremities. The technique requires scanning with multidetector helical CT after rapid intravenous injection of iodinated contrast material. The CT angiographic signs of arterial injuries in the extremities are active extravasation of contrast material, pseudoaneurysm formation, abrupt narrowing of an artery, loss of opacification of a segment of artery, and arteriovenous fistula formation. Metallic streak artifact, motion artifact, and inadequate arterial opacification may render a CT angiogram nondiagnostic. Studies have shown the sensitivity of CT angiography to be 90%-95.1% and its specificity 98.7%-100% for detecting arterial injury to the extremities after trauma.

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Indications for angiography in extremity trauma

Cited by 60 publications

References 1 publication

The Role of Interventional Radiology in Trauma

The Role of Interventional Radiology in Trauma

Emergency Arteriography in the Assessment of Penetrating Trauma to the Lower Limbs

Diagnosing Traumatic Arterial Injury in the Extremities with CT Angiography: Pearls and Pitfalls

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