1: J Vasc Surg  1990 Jan;11(1):84-92; discussion 92-3 

New perspectives on the management of penetrating trauma in proximity to major
limb arteries.

Dennis JW, Frykberg ER, Crump JM, Vines FS, Alexander RH.

Department of Surgery, University of Florida Health Science Center/Jacksonville.

Current management of penetrating injuries in the proximity of major extremity
arteries with no evidence of vascular trauma remains controversial. A total of
318 such injuries in 254 patients were evaluated prospectively to clarify the
appropriate timing and role of arteriography, as well as the natural history of
these injuries. The arteries at risk were: axillary, 47; brachial, 57;
superficial femoral, 176; and popliteal, 38. No deaths occurred, and no
morbidity resulted from arteriographic delay of 6 to 24 hours after injury. Of
the 48 arteriographic abnormalities detected, 16 involved noncritical branch
vessels. There were 32 injuries to major arteries (10.0%), including localized
narrowing (n = 13), intimal flap (n = 12), false aneurysm (n = 6), and
arteriovenous fistula (n = 1). Shotgun wounds led to a greater arterial injury
rate (3/17; 17.6%) than did gunshot wounds (24/247; 9.7%) or stab wounds (5/54;
9.3%). At the surgeon's discretion, three injuries underwent immediate
exploration (one negative), whereas the remaining 29 vessel injuries were
followed up nonoperatively by repeat arteriography (n = 22) or clinical
examination (n = 7), for a mean interval of 2.8 months. Fifteen abnormalities
resolved, 10 improved or remained unchanged, and 4 worsened. The four lesions
(13.7%) that worsened (two shotgun and two axillary artery injuries) were
identified within 3 months of injury and repaired surgically with no morbidity.
In conclusion, only 6 operations were required out of 3218 potential injuries
(1.8%), suggesting that routine arteriography is not a cost-effective means of
evaluating these injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID: 2296106 [PubMed - indexed for MEDLINE]