title: CT angiography effectively evaluates extremity vascular trauma.
abstract: Traditionally, conventional arteriography is the diagnostic modality of choice to evaluate for arterial injury. Recent technological advances have resulted in multidetector, fine resolution computed tomographic angiography (CTA). This study examines CTA for evaluation of extremity vascular trauma compared with conventional arteriography. Our hypothesis is that CTA provides accurate and timely diagnosis of peripheral vascular injuries and challenges the gold standard of arteriogram. Traumatic extremity injuries over a 5-year period were identified using a Level I trauma center registry and radiology database. Information collected included patient demographics, mechanism, imaging modality, vascular injuries, management, and follow-up. Two thousand two hundred and fifty-one patients were identified with extremity trauma. Twenty-four patients were taken directly to the operating room for evaluation and management of vascular injuries. Fifty-two underwent vascular imaging. Fourteen patients had conventional arteriograms with 13 abnormal studies: 7 were managed operatively, 2 embolized, and 4 observed. Thirty-eight patients underwent CTA with 17 abnormal scans: 9 were managed operatively, 3 embolized, and 5 observed. There were no false negatives or missed injuries. CTA provides accurate peripheral vascular imaging while additionally offering advantages of noninvasiveness and immediate availability. Secondary to these advantages, CTA has supplanted arteriography for initial radiographic evaluation of peripheral vascular injuries at our Level I trauma center. This study supports CTA as an effective alternative to conventional arteriography in assessing extremity vascular trauma.
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Stanford University Medical Center, Stanford, California 94305, USA.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Peng
authors.forename: David A
authors.initials: DA
authors.lastname: Spain
authors.forename: Monika
authors.initials: M
authors.lastname: Tataria
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Hellinger
authors.forename: Geoffrey D
authors.initials: GD
authors.lastname: Rubin
authors.forename: Susan I
authors.initials: SI
authors.lastname: Brundage
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000792:Angiography / Q000379:methods*; D001132:Arm / Q000098:blood supply*; D001808:Blood Vessels / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008875:Middle Aged; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging*