Refining the indications for arteriography in penetrating extremity trauma: a prospective analysis

J Vasc Surg. 1993 Jan;17(1):116-22; discussion 122-4. doi: 10.1067/mva.1993.42588.


Purpose: Five hundred fourteen consecutive patients with an isolated upper or lower extremity penetrating injury were entered into a prospective study designed to refine the indications for diagnostic arteriography.

Methods: Twenty-two (4%) patients with limb-threatening ischemia who required immediate operation and 23 (4%) who refused arteriography were excluded from subsequent analyses. The remaining 469 patients were classified as being at high, intermediate, or low risk for an arterial injury.

Results: Two hundred thirteen patients who were at low risk were observed for 24 hours, discharged, and monitored as outpatients. No delayed complications of an arterial injury developed in any patient in this group. The intermediate-risk group of 151 patients and the high-risk group of 105 patients underwent arteriography. Seventy-seven injuries were identified; 24 were major (limb-threatening) and 53 were minor. Fourteen major injuries required operative repair or transcatheter embolization; the remaining 10 nonocclusive major injuries were observed without sequelae.

Conclusions: By step-down logistic regression only pulse deficit (p < 0.01) and an ankle/brachial or wrist/brachial index less than 1.00 in the injured extremity (p < 0.03) were found to be significant predictors of an arterial injury. The presence of either of these two clinical variables successfully predicted all major arterial injuries. This prospective study supports the proposition that arteriography that is limited only to those patients who have either a pulse deficit or minimum ankle/brachial or wrist/brachial index less than 1.00 successfully detects all significant arterial injuries.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Angiography* / statistics & numerical data
  • Arm / blood supply
  • Arm Injuries / classification
  • Arm Injuries / diagnostic imaging*
  • Arm Injuries / epidemiology
  • Female
  • Humans
  • Ischemia / classification
  • Ischemia / diagnostic imaging
  • Ischemia / epidemiology
  • Leg / blood supply
  • Leg Injuries / classification
  • Leg Injuries / diagnostic imaging*
  • Leg Injuries / epidemiology
  • Los Angeles / epidemiology
  • Male
  • Middle Aged
  • Prospective Studies
  • Regression Analysis
  • Risk Factors
  • Wounds, Penetrating / classification
  • Wounds, Penetrating / diagnostic imaging*
  • Wounds, Penetrating / epidemiology