PROXIMITY PENETRATING EXTREMITY TRAUMA - THE ROLE OF DUPLEX ULTRASOUND IN THE DETECTION OF OCCULT VENOUS INJURIES

The diagnosis and management of occult vascular injuries caused by pen etrating proximity extremity trauma (PPET) remains controversial, Over 18 months, we prospectively screened 37 patients (43 lower extremitie s) with PPET for occult arterial and venous injuries using noninvasive studies (physical examination, ankle-brachial indices, color-flow dup lex ultrasonography (CFD)) and angiography (arteriography, venography) . Eight isolated, occult venous injuries were detected (incidence, 22% ), CFD detected seven of eight (88%) venous injuries, Venography was t echnically difficult to perform in this patient population and failed to detect four femoral-popliteal vein injuries, Major thromboembolic c omplications (pulmonary embolism, symptomatic deep vein thrombosis, ve nous claudication) occurred in 50% of the patients identified with fem oral-popliteal vein injuries, Arterial injuries were detected in 4 of 42 (10%) extremities (arteriography, n = 3; CFD, n = 1) and were clini cally benign, We conclude that following PPET, (1) isolated, occult ve nous injuries are common and are associated with significant complicat ions and (2) CFD is useful for screening for occult venous injuries.