Penetrating Proximity Injuries — The Role of Duplex Scanning: A Prospective Study

Author： Edwards Janis W. Bergstein Jack M. Karp Donna L. Cato Ruth F. Towne Jonathan B.

Publisher： Society for Vascular Ultrasound

ISSN： 1539-5898

Source： Journal of Vascular Technology, Vol.17, Iss.5, 1993-10, pp. : 257-261

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Abstract

There is a low incidence of vascular injury in patients with penetrating extremity trauma in proximity to major vessels without obvious clinical signs of vascular injury. Reported incidence of positive angiograms in this group of patients ranges from 0 to 20%. In order to determine if noninvasive arterial evaluation could replace angiography, we prospectively compared color flow duplex imaging (CFDI) to arteriography to evaluate the role of CFDI as a potential screening tool in patients with suspected occult vascular injury after penetrating trauma.Eighty-one patients incurred 86 penetrating injuries to the extremities without apparent arterial injury. There were 80 negative and 6 positive CFDI examinations. Arteriography was performed on all patients. When compared to arteriography, CFDI had a sensitivity of 71%, specificity of 99%, positive predictive value of 83%, negative predictive value of 98%, and an accuracy of 97%. The two false-negative examinations were both small pseudoaneurysms, one occurring in an axillary artery and the other originating from a radial artery with an abnormally high take off in the mid upper arm. The false-positive examination was a pseudoaneurysm of a genicular artery that was misread as arising from the popliteal artery. One patient with a negative duplex scan and negative arteriogram for superficial femoral artery injury required a percutaneous distal embolization of a bleeding muscular branch of the superficial femoral artery due to a slowly expanding hematoma.CFDI is valuable in the evaluation of patients with penetrating proximity injuries involving the arm and leg if the technologist is aware of potential anatomic variations and pitfalls.