title: Emergency room retrograde transbrachial arteriography for the management of axillosubclavian vascular injuries.
abstract: BACKGROUND
  Our purpose was to determine the accuracy of single-injection, retrograde transbrachial arteriography (RTBA), performed in the emergency room, for suspected axillosubclavian injuries.
  
  
  METHODS
  Thirty-three patients were prospectively assigned for RTBA. Clinical indications for RTBA included high-risk mechanism of injury, decreased (n = 19) or absent (n = 5) brachial pulse, neurologic deficits (n = 11), external or intrathoracic bleeding (n = 4), and bruit (n = 2). Brachial artery was cannulated with an 18-gauge catheter. A sphygmomanometer cuff was placed at the forearm and inflated to 250 mm Hg. Twenty milliliters of nonionic contrast media was injected countercurrent and a single anteroposterior chest radiograph was obtained. Small intimal flaps were followed by serial ultrasound. Surgical findings were used to establish RTBA accuracy.
  
  
  RESULTS
  RTBA was successfully performed in all cases. Arterial lesions were detected in 28 (84.8%) patients, including thrombosis (n = 8), arteriovenous fistula (n = 8), and false aneurysm (n = 7) as the most frequent lesions. A sensitivity of 96.5%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 80% were observed with RTBA.
  
  
  CONCLUSIONS
  We conclude that RTBA is a safe and accurate technique to be used in the emergency room for the rapid detection of axillosubclavian arterial injuries.
authors.affiliation: Department of Surgery, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Newton R
authors.initials: NR
authors.lastname: Aerts
authors.forename: Luiz F
authors.initials: LF
authors.lastname: Poli de Figueiredo
authors.forename: Emil
authors.initials: E
authors.lastname: Burihan
mesh_terms: D000328:Adult; D000792:Angiography; D001366:Axillary Artery / Q000000981:diagnostic imaging* / Q000293:injuries; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies