title: Vascular proximity: is it a valid indication for arteriography in asymptomatic patients?
abstract: The role of arteriography in asymptomatic patients with penetrating extremity wounds in proximity to major vessels is controversial. This prospective study was designed to evaluate a precise definition of proximity, determine the incidence of positive arteriograms, and correlate angiographic interpretation with operative findings. Proximity was defined as any wound located within 1 cm of a major vessel. Excluded were patients with a pulse deficit, bruit, thrill, history of arterial hemorrhage, expanding hematoma, nerve deficit, fracture, or significant soft-tissue injury. One hundred sixty arteriograms were performed in 146 patients. One hundred forty-three (89.4%) were true-negatives. Seventeen (10.6%) were suggestive of injury. These included seven (4.4%) true-positive arteriograms, six (3.8%) false-positive studies, and four (2.5%) positive arteriograms in patients who were not operated upon. The angiographic report correlated with operative findings in five (38.5%) of 13 patients. These data confirm the low incidence (4.4%) of vascular injury in asymptomatic patients. The use of extremity angiography when proximity is the sole indication in an asymptomatic patient with a normal vascular examination must be questioned.
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas.
authors.forename: H
authors.initials: H
authors.lastname: Francis
authors.forename: E R
authors.initials: ER
authors.lastname: Thal
authors.forename: J A
authors.initials: JA
authors.lastname: Weigelt
authors.forename: H C
authors.initials: HC
authors.lastname: Redman
mesh_terms: D000328:Adult; D000792:Angiography; D001158:Arteries / Q000293:injuries*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D010808:Physical Examination; D011446:Prospective Studies; D014950:Wounds, Penetrating / Q000150:complications / Q000000981:diagnostic imaging*