A Reappraisal of Exclusion Angiography in Gunshot Wounds of the Extremities

The routine use of exclusion angiography in trauma to the extremities has resulted in varying percentages of negative studies, mostly because of a great variability in location and type of injury. The authors reviewed 117 low-velocity gunshot wounds to the extremities. Twenty-six cases presented with hard signs of vascular injury and underwent immediate exploration. Ninety-one exclusion angiograms were performed (11 for soft signs and 80 for proximity only), 89 (98%) were considered negative. Two cases (2 %) that presented without hard signs required vascular repair. Physical examination alone was 93 % sensitive and 99 % specific for recognition of vascular injuries. Routine angiography did not substantially improve the diagnostic accuracy and had a positive predictive value of only 2%. The authors conclude that angiography may be safely omitted in low-velocity gunshot wounds to the extremities if the absence of signs or symptoms of vascular injury can be firmly established.