THE SUCCESS OF DUPLEX ULTRASONOGRAPHIC SCANNING IN DIAGNOSIS OF EXTREMITY VASCULAR PROXIMITY TRAUMA

Objective: To determine if duplex ultrasonographic scanning is diagnos tically equivalent to arteriography and/or operative exploration in th e diagnosis of extremity vascular proximity trauma. Design: A prospect ive evaluation comparing duplex scanning with arteriography or operati ve exploration in 50 patients. Subsequently, duplex scanning was used alone for 175 extremity vascular proximity injuries, with other diagno stic methods used when injury was indicated on the duplex scan. Settin g: A busy urban trauma center. Patients: Consecutive sample of 200 pat ients with 225 extremity injuries. Selection Criteria: Vascular proxim ity injury or diminished strength of the extremity pulse. Main Outcome Measures: The presence or absence of vascular proximity injury confir med on angiography and/or operative exploration. Results: Duplex scann ing had 100% sensitivity and 100% specificity compared with arteriogra phy and/or operative exploration in the first 50 cases. In the remaini ng 175 cases of extremity trauma, vascular injuries were diagnosed wit h duplex scanning alone. Duplex scanning detected 18 injuries, 17 of w hich were confirmed by correlation with arteriograms and/or operative exploration. One false-positive result-spasm of the superficial femora l artery-was found on arteriography. Seven unsuspected venous injuries were also diagnosed. Conclusions: Duplex scanning is a noninvasive, s ale, effective method for the initial evaluation of potential extremit y vascular proximity injury. It has replaced arteriography in the init ial diagnosis of extremity vascular proximity trauma by our trauma ser vice.