ADVERSE OUTCOME OF NONOPERATIVE MANAGEMENT OF INTIMAL INJURIES CAUSEDBY PENETRATING TRAUMA

Purpose: The objective of this study was to determine adverse outcomes associated with the nonoperative management of intimal injuries. Meth ods: A five-year retrospective review of 118 patients admitted with so ft signs of vascular injury to two level I trauma centers was conducte d. All injuries evaluated were isolated penetrating injuries. The numb er of major arteries at risk were 16 axillary, 31 brachial, 36 common femoral, 22 superficial femoral, and 13 deep femoral. Twenty-three ang iographic abnormalities were identified in 23 limbs. Seven injuries we re categorized as ''minor'' intimal flaps and treated with observation alone. The remainder were explored during operation. Results: During the follow-up period, six of the seven patients treated without operat ion returned to either the outpatient clinic or emergency department w ith acute onset of pain or paresthesia in the previously injured limb. The following abnormalities were identified with angiography: one axi llary artery thrombosis, one brachial artery pseudoaneurysm, two commo n femoral thromboses, two superficial femoral artery/superficial femor al vein fistulas, and one deep femoral artery pseudoaneurysm. Al the a bnormalities mere repaired with operation. Conclusions: The benign nat ure of intimal injury identified with angiography may be overemphasize d. The results of long-term follow-up in patients with this type of in jury must be reviewed before ''observation alone'' can be recommended as standard treatment.