title: The natural history of clinically occult arterial injuries: a prospective evaluation.
abstract: 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.
authors.affiliation: Department of Surgery, University of Florida College of Medicine, University Hospital, Jacksonville 32209.
authors.forename: E R
authors.initials: ER
authors.lastname: Frykberg
authors.forename: F S
authors.initials: FS
authors.lastname: Vines
authors.forename: R H
authors.initials: RH
authors.lastname: Alexander
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000209:etiology / Q000601:surgery; D000792:Angiography; D001158:Arteries / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013382:Subtraction Technique; D014949:Wounds, Nonpenetrating / Q000628:therapy*; D014950:Wounds, Penetrating / Q000628:therapy*