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Angiographic Findings of Patients with Blunt or Penetrating Extremity Injuries: Focus on Indications and Contraindications

Authors

1 Assistant professor of radiology. Associate professor of vascular surgery. Vascular and Endovascular surgery research center, Department of vascular surgery, Emamreza Hospital, Faculty of medicine, Mashhad University of Medical Sciences

2 Associate professor of vascular surgery Vascular and Endovascular surgery research center, Emamreza Hospital, Faculty of medicine, Mashhad University of Medical Sciences

3 Vascular and Endovascular surgery research center, Emamreza Hospital, Faculty of medicine, Mashhad University of Medical Sciences

4 General practitioner. Vascular and Endovascular surgery research center, Emamreza Hospital, Faculty of medicine, Mashhad University of Medical Sciences

Abstract

Objective: To determine the etiology, signs and symptoms, angiography indications and angiography findings in patients with limb penetrating injuries suspected to have arterial injury.Methods: This was a cross-sectional study being performed in Imam Reza Hospital affiliated with Mashhad University of Medical Sciences, Iran between September 2011 and March 2013. We included those patients with extremity blunt and penetrating injuries who were referred for angiography according to standard indications including abnormal distal pulses, complex fracture or dislocation, vascular proximity, fixed hematoma, distal nerve deficit, arterial bruit, thrill and massive soft tissue injuries.Results: During the study period, 148 patients (15 women and 133 men) with a mean age of 31±14.9 (11-82) years were evaluated. The most common cause of injury was motor vehicle accident (127 patients 85%). Angiography indications included abnormal distal pulse examination (124, 83.8%), complex fracture or dislocation (7, 4.7%), near arterial trauma (4, 2.7%), fixed hematoma (3, 2%), nerve damage (1, 0.7%). The angiography was found to be normal in 49 (33.1%) patients. In patients with abnormal angiography findings, 60 (60.6%) had cutoff with distal runoff, 21 (21.2%) had cutoff without runoff, 14 (14.1%) had arterial spasm. Other uncommon findings included active bleeding in 2 patients (2%), pseudoaneurysm in 1 (0.7%) and arteriovenous fistula in 1 (0.7%). Out of 4 patients (2.7%) with vascular proximity, only 1 (0.7%) had abnormal angiography.Conclusion: The most  important  factor in prediction  of result of angiography was distal arterial pulses examination. But these data confirm the low incidence of vascular injury in asymptomatic patients with proximity. So the use of angiography when proximity is the sole indication in an asymptomatic patient with a normal vascular examination should be questioned.

Keywords

References
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Bulletin of Emergency And Trauma
Volume 2, Issue 1 - Serial Number 1
6
January 2014
Pages 27-31
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