DUPLEX SCANNING REPLACES ARTERIOGRAPHY AND OPERATIVE EXPLORATION IN THE DIAGNOSIS OF POTENTIAL CERVICAL VASCULAR INJURY

BACKGROUND: The pursuit of a diagnosis is more aggressive in suspected cervical vascular injury than in extremity vascular proximity injury, since the complications of missing the neck injury may result in irre versible neurologic damage. Most institutions use arteriography and op erative exploration, but these modalities identify only 10% of cervica l vascular traumas. While duplex scanning is the screening test of cho ice for carotid occlusive disease, few published reports have describe d experience with this modality in cervical vascular trauma. PATIENTS AND METHODS: To determine if duplex scanning can replace arteriography or operative exploration as the initial screening modality in the ass essment of potential cervical vascular trauma, we performed a prospect ive evaluation in two parts. First, we used duplex scanning and cervic al arteriography, concomitantly, to rule out injury in 15 patients. We then used duplex scanning alone in 85 patients, reserving arteriograp hy for cases in which the scan revealed an arterial injury. RESULTS: D uplex scans and arteriography and operation diagnosed cervical vascula r trauma equally well. Eight injuries were identified in all areas of the cervical arterial tree. No duplex scans have been falsely negative or falsely positive, Use of duplex scans instead of arteriography sav ed $1,252 per case. C CONCLUSIONS: Duplex scanning detects cervical va scular injuries as effectively as arteriography or operation, and is f aster and less expensive. This approach expands the utility of diagnos tic ultrasound in the evaluation of trauma patients. It has become the procedure of choice for diagnosing cervical vascular trauma at our in stitution.