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During an 18-month period, 53 patients with unilateral blunt lower-extremity trauma
were entered into a prospective study designed to determine how often clinically occult
arterial injuries are identified by routine arteriography, and how often these injuries
are of sufficient magnitude to warrant therapeutic intervention. Patients underwent
diagnostic arteriography if one or more of the following abnormal clinical findings
were present: distal pulse deficit, nerve deficit, soft-tissue loss, decreased capillary
refill, bruit, or a history of hemorrhage or hypotension. In the absence of these
findings, arteriography was performed for significant orthopedic injuries, i.e., knee
dislocations or complex longbone fractures. In 31 patients (58%), arteriography was
performed because 1 or more abnormal clinical findings were present and 12 arterial
injuries were identified, 4 requiring arterial repair. The presence of a knee dislocation
or complex longbone fracture was the only indication for arteriography in 22 patients
(42%) and 3 arterial injuries were identified, none requiring operative intervention.
For all patients, two variables, pulse deficit and delayed capillary refill, strongly
correlated (p<0.05) with arteriographic demonstration of an arterial injury. In the
absence of these findings, routine diagnostic arteriography will have a low diagnostic
yield and will rarely identify a vascular injury in a major artery that will require
operative repair. Arteriography should be selectively performed and guided by examination
and noninvasive Doppler indices.
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Article info
Footnotes
3Presented at the 18th Annual Meeting of the Society for Clinical Vascular Surgery, Palm Desert, California, March 7–11, 1990.
Identification
Copyright
© 1990 Reed Publishing USA. Published by Elsevier Inc.
