1: J Trauma  1989 Aug;29(8):1041-50; discussion 1050-2 

A reassessment of the role of arteriography in penetrating proximity extremity
trauma: a prospective study.

Frykberg ER, Crump JM, Vines FS, McLellan GL, Dennis JW, Brunner RG, Alexander
RH.

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

Penetrating proximity extremity trauma (PPET) was prospectively studied to
clarify the role of routine arteriographic evaluation (AG). Over a 24-month
period, 135 patients were identified with 152 injuries from PPET. All patients
underwent AG and were randomized to either immediate or delayed timing. There
were 27 arteriographic abnormalities from these 152 wounds, of which 16 (10.5%)
were in major arteries. One acute arteriovenous fistula underwent immediate
surgery. The remaining 15 major vessel injuries were nonoperatively observed,
including seven cases of segmental arterial narrowing, six intimal flaps, and
two small pseudoaneurysms (one of which enlarged and underwent surgical repair
after 10 weeks of followup). Nine of the remaining 14 lesions resolved; two
improved and three remained clinically unchanged over a mean followup interval
of 2.7 months. Shotgun trauma was the mechanism which carried the greatest risk
of significant vascular injury. Although "soft" clinical signs were
significantly more predictive of vascular injury following PPET than proximity
alone (p less than 0.0005), 50% of all injuries to major arteries did not
manifest soft signs. No extremity morbidity resulted from delayed AG or from
vascular injury management. We conclude from our study population: 1) the
natural history of clinically occult arterial injuries was predominantly benign;
2) AG could be safely delayed up to 24 hours; 3) "soft" signs were not
clinically useful predictors of vascular injury; and 4) with the exception of
shotgun wounds, AG did not appear to be a cost effective screening modality,
since detection of a single vascular injury requiring surgery cost $66,420.00.

Publication Types:
    Clinical Trial
    Randomized Controlled Trial

PMID: 2503620 [PubMed - indexed for MEDLINE]