THE ROLE OF EMERGENT ARTERIOGRAPHY IN PENETRATING LIMB TRAUMA

Routine arteriographic evaluation of patients with penetrating trauma in proximity to major limb arteries has been declining in popularity. Although some controversy still exists, management based on clinical e xamination alone has been advocated for those without overt signs of v ascular injury. To better identify the need for invasive radiologic in tervention, 453 limbs (394 patients) sustaining gunshot, shotgun, and stab wounds (331, 28, and 94, respectively) in proximity to a major ar tery underwent angiography from 1984 through 1990. An arterial injury was demonstrated in 37 (9.4%) of 394 limbs, with a normal vascular exa mination, but only eight (2.0%) were deemed to require operative inter vention. By comparison, 45 (76%) of 59 patients with an abnormal vascu lar examination (diminished/absent peripheral pulses or decreased Dopp ler-derived limb blood pressures) had an arterial injury demonstrated by arteriography, with 33 (55.9%) undergoing operative repair. The pre sence of an associated long bone fracture increased the incidence of a ngiographically demonstrated vascular injury, but operative interventi on was only increased for those with an abnormal vascular exam. A deta iled physical examination including Doppler-derived limb blood pressur es is essential. In the presence of a normal vascular exam, routine ar teriography for proximity of injury is unnecessary. Arteriography shou ld be reserved to identify those few patients with an abnormal vascula r examination and an unclear injury who may require vascular repair,