Blunt lower-extremity trauma and popliteal artery injuries: revisiting the case for selective arteriography.
OBJECTIVE
Abandoning mandatory angiography in patients with blunt lower-extremity trauma and normal neurovascular examination results does not affect limb salvage.


METHODS
Retrospective, nonrandomized cohort study. Mean follow-up (31 of 52 patients) of 9.5 months (range, 0-96 months).


METHODS
Single-institution, academic level I trauma center.


METHODS
Medical records of patients presenting on an emergency basis with knee dislocation, distal femoral fractures, or proximal tibial fractures during a 20-year period were reviewed. Fifty-three injuries occurred in 52 patients. Patients were predominantly male (81%) and young (mean age, 32.7 years). Mechanisms and side of extremity injury, coincident injuries, and neurovascular status on admission were recorded. Hard signs of arterial insufficiency or compartment syndrome were identified.


METHODS
Angiographic findings and operative and nonoperative interventions were recorded to identify whether angiographic data would alter therapy dictated by clinical findings alone.


METHODS
Limb salvage rate and necessity for vascular surgical intervention based on angiographic data in patients with normal neurovascular examination results.


RESULTS
Multiorgan trauma occurred in 11 patients. Pulses were normal in 35, absent in 16, and diminished or identified by Doppler signal in 2. Arterial insufficiency or compartment syndrome was present in 29%. Twenty-seven patients (28 limbs) underwent angiography at the discretion of the attending surgeon. Of 13 abnormal arteriograms, 2 occurred in patients with normal pulses and 11 in patients with abnormal examination results. Thirteen of 36 patients with normal pulses underwent angiography; none had clinically significant arterial injuries that necessitated intervention. No vascular interventions were necessary in 23 patients with normal pulses who did not undergo angiography (P<.001). Normal neurovascular status bore a 100% negative predictive value in determining the necessity of vascular intervention.


CONCLUSIONS
Angiography is unnecessary in the routine evaluation of the patient with blunt lower-extremity trauma who presents with a normal neurovascular examination result and can be used selectively for patients with diminished pulses who lack associated indications for mandatory operative exploration.
Abou-Sayed
Hatem
H
General Surgical Services, Massachusetts General Hospital, 15 Parkman St, Boston, MA 02114, USA.
Berger
David L
DL
D000328:Adult; D000792:Angiography; D015331:Cohort Studies; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging*; D007718:Knee Injuries / Q000000981:diagnostic imaging*; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging*; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*