1: J Trauma  1989 May;29(5):577-83 

The natural history of clinically occult arterial injuries: a prospective
evaluation.

Frykberg ER, Vines FS, Alexander RH.

Department of Surgery, University of Florida College of Medicine, University
Hospital, Jacksonville 32209.

Nineteen patients with 20 clinically occult arterial injuries were prospectively
followed without surgery in order to define the natural history of these
lesions. The patients were predominantly male (74%), with a mean age of 31
years. The mechanism of injury was penetrating in 13 cases and blunt in seven
cases. The arterial injuries were located in the lower extremity (45%), upper
extremity (35%), neck (15%), and abdominal aorta (5%). Neurologic trauma (55%)
and musculoskeletal trauma (40%) were the most common associated injuries. There
was no clinical manifestation of vascular injury in any case. All lesions were
identified by arteriography, which was performed for high-risk blunt trauma and
proximity of penetrating wounds to major vessels. Intimal flap was the most
commonly demonstrated form of injury (65%), followed by focal narrowing (30%)
and false aneurysm (5%). Followup of 19 injuries (95%) was obtained for periods
ranging from 3 days to 19 months (mean, 3.8 months). Arteriographic followup was
obtained in 15 cases (79%). One injury (5%), a false aneurysm, enlarged after 10
weeks and was surgically repaired without clinical sequelae. All other lesions
either resolved (53%), improved (16%), or remained unchanged (26%). These
results suggest that nonoperative observation may be a safe and feasible method
of managing clinically occult arterial injuries.

PMID: 2657082 [PubMed - indexed for MEDLINE]