Prospective Evaluation of Multidetector Computed Tomography for Extremity Vascular Trauma

Abstract

Physical examination is critical in the decision-making process for the injured extremity and can accurately reduce unnecessary imaging. If imaging is required, MDCTA is a sensitive and a specific noninvasive modality for arterial evaluation and may replace conventional angiography as the diagnostic modality of choice for the evaluation of the acutely injured extremity.

Revascularisation of left hand after 33 hours of warm ischemia: a case report

“…However, in our case we couldn"t perform as the patient was not financially well equipped to go through it and also considering the time we had for the procedure to be done. 28,29 The positive aspect of this case is the fact that a successful revascularization after 33 hours of warm ischemia of hand. As mentioned, very few cases have been reported till today"s date with a prolonged ischemia time including the notable case of Nanda et al and A M Merican et al (warm ischemia time of 10 hours).…”

Management of penetrating injuries of the upper extremities

“…Together, they have shown to be a reliable indicator of clinically significant injury, with a sensitivity of 99% and a negative predictive value of 99% in patients with PUET. [5,13] The present study was done in a high-volume, tertiary referral trauma center for penetrating injuries, which manages about 800 patients with penetrating extremity injury each year. The management protocol for assessing and treating patients with PUET is based essentially on hemodynamic status, together with a thorough physical examination.…”

“…[1,4] Although rapid detection, localization and specification of a vascular injury in these patients are essential for the effective management of PUET, it is ill-advised to perform diagnostic computed tomography angiography (CTA) or conventional angiography in every patient. [5][6][7] Over 90% of CTAs in these patients will be negative, representing a large cost as a screening tool. [7] ORIGINAL ARTICLE Ulus Travma Acil Cerrahi Derg, September 2013, Vol.…”

“…19, No. 5 Based on the experience from high-volume hospitals in developing countries, selective screening based on physical examination is gaining in favor. The accuracy of the physical examination to detect vascular injury is very high in patients after penetrating trauma.…”

Penetrating nontorso trauma: the extremities

“…Given recent improvements in the fidelity of CT (i.e., 3-dimensional reconstruction), CTA is the first choice of many clinicians. 12 If, however, the surgeon's pretest probability of a vascular injury is high (concerning clinical exam and ABI < 0.9), angiography at the time of operative exploration may be more expedient. Although patency of most lower-extremity vascular repairs should be confirmed with an angiogram before leaving the operating suite, the return of distal pulses, capillary refill and warmth to the injured upper limb is usually sufficient to avoid a formal study.…”