Angiography in the evaluation of proximal arterial injury

The appropriate use of angiography in the evaluation of possible peripheral arterial trauma is still controversial. At the Johns Hopkins Hospital during the past two years, 78 traumatic injuries were evaluated angiographically in 70 consecutive patients, including 63 men and seven women, ranging in age from five to 78 years (mean of 26.5 years). There were 63 gunshot, five stab, three shotgun and seven blunt injuries. Fifty-two involved the lower extremity; 21, the upper extremity; two, the buttock; two, the neck, and one, the pelvic region. Indications for study included proximal injury in 59, abdominal pulse examination in six, expanding hematoma in four, neurologic abnormality in six and bleeding and hypotension in three. Arterial abnormalities were documented in 11 of these injuries, including five of injuries with an abnormal pulse, two with bleeding and hypotension, two with an expanding hematoma, one with a neurologic deficit and one of proximal injuries. There were no false-positive arteriograms. The results of this study demonstrate that exclusion angiography is safe and accurate, but probably overused in the patient with proximal injury in the absence of other clinical signs.