Is Routine Arteriography Mandatory for Penetrating Injuries to Zone 1 of the Neck?

Abstract

Patients with penetrating wounds to zone I who have no evidence of vascular injury on PE and who have normal findings on CXR may not require routine arteriography. Further study is needed to confirm these findings.

Selective management of penetrating neck injuries using “no zone” approach

“…Demetriades et al [10] conducted a prospective trial evaluating the use of physical examination in PNI patients; they demonstrated that the lack of hard signs of vascular and aerodigestive tract injuries could reliably exclude the need for operative repair with the negative predictive value of 100%. Retrospective studies also showed that physical examination, combined with a negative chest X-ray; could be used to rule out significant vascular injuries (negative predictive value 100%) in zone I PNI patients [14,15]. Hence, observation alone in asymptomatic PNI patients, regardless of the zone, seems to be a safe approach.…”

Prospective Evaluation of Screening Multislice Helical Computed Tomographic Angiography in the Initial Evaluation of Penetrating Neck Injuries

“…[1][2][3][4][5][6][7][8][9][10][11][12] At this time, despite the vast amount of research completed in this area, no unified consensus on the optimal management strategy for penetrating neck injuries exists.…”

“…For the remaining patients, management options include mandatory exploration, mandatory imaging, and selective physical examination directed imaging and intervention. [1][2][3][4][5][6][7][8][9][10][11][12] Mandatory exploration of the neck is associated with a high rate of negative exploration with its attendant risks, time, cost and potential for complication. Mandatory screening of all patients with imaging also has its drawbacks.…”

Penetrating nontorso trauma: the head and the neck

“…Penetrating injuries to zones 1 and 3 parlay notorious difficulty in obtaining emergent surgical access and therefore require an urgent CT screening examination to rule out injury in the presence of any abnormality detected on physical examination or chest radiograph. 2 Vascular injury in particular can be studied with CT angiography, 3 percutaneous angiography or duplex ultrasonography, 4 depending on the resource profile of a given centre. Metal fragments (missile, shrapnel) may create artifact limitations that are more easily bypassed using formal percutaneous angiography.…”