Delayed diagnosis of arterial injuries.
During an 8 1/2 year period, 28 patients with a delayed diagnosis of an arterial injury in an extremity or the neck were treated. The median delay between injury and diagnosis was 10 days. The tibio-peroneal arteries were the most commonly injured vessels. After extensive analysis of the records and arteriograms of the involved patients, the following conclusions were drawn: Arteriograms are mandatory for penetrating wounds proximal to major arteries of the extremities because of the 5 to 15 percent incidence of occult injuries; the timing of arteriography in the distal leg is critical if subtle injuries to the tibial and peroneal vessels are to be detected; when experienced radiologists are not available, interpretation of exclusion arteriograms is best performed by experienced trauma surgeons; false aneurysms, arteriovenous fistulas, or a combination of both continue to be the most common manifestations of missed arterial injuries; failure to find an injury previously diagnosed by a preoperative arteriogram mandates an intraoperative arteriogram and, on occasion, an arteriotomy; and, late arterial repairs usually require segmental resection with an end-to-end anastomosis or insertion of a graft.
Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston, Texas 77030.
D V
DV
Feliciano
P A
PA
Cruse
J M
JM
Burch
C G
CG
Bitondo
D000328:Adult; D000792:Angiography; D001132:Arm / Q000098:blood supply; D001158:Arteries / Q000293:injuries* / Q000601:surgery; D001807:Blood Vessel Prosthesis; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008026:Ligation; D008297:Male; D009333:Neck / Q000098:blood supply; D013997:Time Factors