title: CT-detected traumatic small artery extremity injuries: surgery, embolize, or watch? A 10-year experience.
abstract: Advances in computed tomography (CT) angiography have increased the sensitivity and specificity of detecting small branch arterial injuries in the extremities of trauma patients. However, it is unclear whether these patients should undergo surgery, angioembolization, or conservative watchful waiting. We hypothesized that uncomplicated small arterial branch injuries can be managed successfully with watchful waiting. A 10-year retrospective review of extremity CT angiograms with search findings of arterial "active extravasation" or "pseudoaneurysm" was performed at a level 1 county trauma center. Subgroup analysis was performed on those with isolated extremity injury and those with concurrent injuries. A total of 31 patients had CT-detected active extravasation (84 %) or pseudoaneurysm (16 %), 71 % of which were isolated vascular injuries. Of the patients evaluated, 71 % (n = 22) were managed with watchful waiting, 19 % (n = 6) with angioembolization, and 10 % (n = 3) with surgery. Watchful waiting complications included progression to alternative treatment (n = 1) and blood transfusions (n = 2). Complications of surgery included the inability to find active bleeding (n = 1) and postoperative psychosis (n = 1). Complications of angioembolization were limited to a postprocedure blood transfusion (n = 1). Patients with isolated vascular injuries had an average length of stay of 2.9 days, with management averages of the following: 2.7 days with watchful waiting (n = 16), 3.3 days with angioembolization (n = 3), and 3.7 days with surgery (n = 3). CT angiography has greatly increased the reported incidence of traumatic arterial injury in the extremity. We propose that small branch arterial injuries in the extremities can be managed successfully with watchful waiting and do not often require immediate embolization.
authors.affiliation: University of California San Francisco, School of Medicine, San Francisco, CA, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Velez
authors.affiliation: University of California San Francisco, School of Medicine, San Francisco, CA, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Surman
authors.affiliation: San Francisco General Hospital, Department of Radiology, 1001 Potrero Ave, SFGH 5, San Francisco, CA, 94110, USA.
authors.forename: Sujal M
authors.initials: SM
authors.lastname: Nanavati
authors.affiliation: San Francisco General Hospital, Department of Radiology, 1001 Potrero Ave, SFGH 5, San Francisco, CA, 94110, USA.
authors.forename: Vishal
authors.initials: V
authors.lastname: Kumar
authors.affiliation: San Francisco General Hospital, Department of Radiology, 1001 Potrero Ave, SFGH 5, San Francisco, CA, 94110, USA.
authors.forename: Evan
authors.initials: E
authors.lastname: Lehrman
authors.affiliation: San Francisco General Hospital, Department of Radiology, 1001 Potrero Ave, SFGH 5, San Francisco, CA, 94110, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Wilson
authors.affiliation: San Francisco General Hospital, Department of Radiology, 1001 Potrero Ave, SFGH 5, San Francisco, CA, 94110, USA. miles.conrad@ucsf.edu.
authors.forename: Miles B
authors.initials: MB
authors.lastname: Conrad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001134:Arm Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D003657:Decision Making; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D057832:Watchful Waiting
keywords: Active extravasation; Arterial injury; Critical care; Pseudoaneurysm