ABSTRACT
Objective: To determine the etiology, signs and symptoms, angiography indications and angiography findings in patients with limb penetrating injuries suspected to have arterial injury
Methods: This was a cross-sectional study being performed in Imam Reza Hospital affiliated with Mashhad University of Medical Sciences, Iran between September 2011 and March 2013. We included those patients with extremity blunt and penetrating injuries who were referred for angiography according to standard indications including abnormal distal pulses, complex fracture or dislocation, vascular proximity, fixed hematoma, distal nerve deficit, arterial bruit, thrill and massive soft tissue injuries
Results: During the study period, 148 patients [15 women and 133 men] with a mean age of 31+/-14.9 [11-82] years were evaluated. The most common cause of injury was motor vehicle accident [127 patients 85%]. Angiography indications included abnormal distal pulse examination [124, 83.8%], complex fracture or dislocation [7, 4.7%], near arterial trauma [4, 2.7%], fixed hematoma [3, 2%], nerve damage [1, 0.7%]. The angiography was found to be normal in 49 [33.1%] patients. In patients with abnormal angiography findings, 60 [60.6%] had cutoff with distal runoff, 21 [21.2%] had cutoff without runoff, 14 [14.1%] had arterial spasm. Other uncommon findings included active bleeding in 2 patients [2%], pseudoaneurysm in 1 [0.7%] and arteriovenous fistula in 1 [0.7%]. Out of 4 patients [2.7%] with vascular proximity, only 1 [0.7%] had abnormal angiography
Conclusion: The most important factor in prediction of result of angiography was distal arterial pulses examination. But these data confirm the low incidence of vascular injury in asymptomatic patients with proximity. So the use of angiography when proximity is the sole indication in an asymptomatic patient with a normal vascular examination should be questioned
ABSTRACT
Objective: To compare the conventional angiographic findings in extremity trauma patients with or without runoff
Methods: This was cross-sectional study including all the patients with extremity trauma who underwent conventional angiography during the 2 year period from 2011 to 2013 in Angiography departments of Mashhad University of Medical Sciences. Mechanism of trauma, type of injury and angiographic findings were recorded in a questionnaire for each patient. After completion of treatment and discharge, the treatment type was added. The characteristics as well as clinical findings were compared between those who were diagnosed to have arterial runoff ad those who did not
Results: One hundred and forty eight traumatic patients including 15 female with age range of 11-82 years and 133 men ranging from 25 to 40 years were enrolled. Abnormal angiographic findings were provided in 99 [66.9%] patients including cutoff with distal runoff [n=60, 60.6% of abnormalities], cut off without distal runoff [n=21, 21.2%] and spasm [n=14, 14.1%] and other findings [n=4, 4%]. Fifty one cases were treated under open surgery and amputation of traumatic limb was done for 13 patients. Amputation rate was higher in patients with cutoff and without runoff than those with cutoff and runoff [33.3% vs. 6.78%; p=0.002]
Conclusion: Causes and types of traumatic arterial injury in our study were different with other reports. It was shown that angiographic findings were less important in prognosis and management of patients. Patients with spasm in angiographic findings had a better prognosis than other patients and mostly did not need any vascular surgery. The presence or absence of a distal run off in primary angiographic findings can have a predictive value in the final amputation rate