Emergency arteriography in extremity trauma: assessment of indications

Two hundred and four cases of extremity trauma were evaluated. Arteriography was performed in 70 patients for one or a combination of the following indications: absent or diminished pulse, proximity to a major vessel, enlarging or significant hematoma, neurologic deficit, fracture or dislocation, or systemic hypotension. Of the 70 patients, 37 (53%) demonstrated positive arteriographic findings; the most common was arterial occlusion. Patients with an absent or diminished pulse, the most reliable indicator of arterial injury, should have immediate arteriography. Patients who have strong and equal peripheral pulses and are clinically stable should be observed and undergo elective arteriography. Three patients with intimal injuries had intact pulses, but no pattern of indications was helpful in identifying these injuries. A combination of indications is indicative of more serious injury and more likely to produce a positive arteriographic study.
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