THE UTILITY OF COLOR-FLOW DOPPLER EXAMINATION IN PENETRATING EXTREMITY ARTERIAL TRAUMA

Recent reports from our institution have demonstrated the safety of no noperative management of minimal arterial injuries. The purpose of thi s pilot study was to evaluate whether color flow Doppler (CFD) examina tion could detect minimal arterial injuries caused by penetrating extr emity trauma. Twelve patients with minimal arterial injuries identifie d by arteriography were treated nonoperatively. Each also underwent co lor flow examination. Seven of 12 arteriographic abnormalities were de tected by color flow examination. Two intimal injuries (brachial arter y, superficial femoral artery (SFA)), one small (1 mm) pseudoaneurysm (popliteal artery), and two minor vessel occlusions (interosseous arte ry, branch off SFA) were not detected. These preliminary data suggest that color flow scans may be less sensitive than arteriography in the detection of clinically insignificant lesions such as small intimal de fects or small vessel occlusions. Despite this, CFD examination was su ccessful in detecting more significant lesions such as pseudoaneurysms , arteriovenous fistulae, and major vessel occlusions. This is relevan t since these lesions may require immediate intervention. These findin gs suggest the possibility that color Doppler sonography may be able t o sequentially monitor these lesions to determine if they resolve or p rogress. If progression is documented they may require surgical correc tion. Further prospective studies must be performed to assess whether color flow Doppler examination can supplant arteriography in patients at low or intermediate risk for arterial injury following penetrating arterial trauma.