Is routine arteriography mandatory for penetrating injuries to zone 1 of the neck?

Objective: Surgical dogma dictates that the evaluation of all penetrating z one 1 neck injuries must include arteriography to reliably exclude arterial injury requiring operation. This study was done to determine whether patie nts with normal findings at physical examination (PE) and on chest radiogra phs (CXR) really do require arteriography to identify occult, surgically im portant arterial injuries. Methods: All penetrating zone 1 neck injuries in five Level I trauma center s over a 10-year period were reviewed retrospectively. Data collected inclu ded demographics, results of PE, CXR findings, other diagnostic studies don e, injuries identified, need for operation, and operative findings. Arteria l injury mas defined as any injury to the aorta or brachiocephalic, subclav ian, vertebral, or carotid arteries found on arteriography, duplex, or at o peration. Results: Of 138 patients studied, there were 28 arterial injuries. Of the t otal group of 138 patients, 36 patients had normal findings at PE and on CX R. None of these 36 patients had an arterial injury. The negative predictiv e value of normal PE and CXR together is 100% in this series. Conclusions: Patients with penetrating wounds to zone I who have no evidenc e of vascular injury on PE and who have normal findings on CSR may not requ ire routine arteriography. Further study is needed to confirm these finding s.