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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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- Complete dislocation of the knee: experience at the Massachusetts General Hospital.J Trauma. 1969; 9: 192-215
- Arterial injuries associated with fractures and or dislocations of the knee.J Trauma. 1977; 17: 775-784
- Popliteal artery injury with fractural dislocation of the knee.Am J Surg. 1981; 142: 36-40
- Selective management of noncclusive arterial injuries.Arch Surg. 1989; 124: 1136-1141
Weaver^FA, Yellin AE, Bauer M, et al. Is arterial proximity a valid indication for arteriography in penetrating extremity trauma? Arch Surg (in press).
- BMDP statistical software.in: Dixon W. University of California Press, Berkeley1988
- Battle injuries of the arteries in World War II.Ann Surg. 1946; 123: 534-571
- Arterial repair during the Korean War.Ann Surg. 1985; 147: 555-561
- Blunt popliteal artery trauma. One hundred consecutive injuries.Arch Surg. 1984; 119: 568-573
- Vascular and orthopedic complications of knee dislocations.Surg Gynecol Obstet. 1979; 149: 554-558
- Knee dislocation: an illusive cause of critical arterial occlusion.Arch Surg. 1976; 11: 1021-1024
- Vascular injuries associated with dislocation of the knee.J Bone Joint Surg. 1979; 59 ([Am]): 236-239
- A reassessment of the role of arteriography in penetrating proximity extremity trauma: a prospective study.J Trauma. 1989; 29: 1041-4052
- Principles in the management of arterial injuries associated with fracture/dislocations.Ann Surg. 1975; 182: 630-634
- Arterial injury complicating knee disruption.Am Surg. 1989; 55: 699-704
3Presented at the 18th Annual Meeting of the Society for Clinical Vascular Surgery, Palm Desert, California, March 7–11, 1990.
© 1990 Reed Publishing USA. Published by Elsevier Inc.