Indications for angiography in extremity trauma

The angiograms of 119 extremities of patients with gunshot wounds (65), lacerating injuries (17), and blunt trauma (29) were retrospectively evaluated and correlated with clinical history. Indications for angiography were decreased or absent pulse or blood pressure, cold limb, bruit or murmur, uncontrolled bleeding or increasing hematoma, neurologic deficit, and proximity of the injury to vascular structures. Angiographic findings were compared with preprocedure clinical assessment. Angiograms performed only because of proximity of the wound/injury to major vessels showed no major arterial injuries. However, angiograms performed for one or more of the other indications demonstrated significant vascular abnormalities in 44% of gunshot wounds, 80% of knife injuries, and 67% of blunt trauma. Of the indications for arteriography, pulse abnormalities or cold limbs were most often associated with significant angiographic findings, positive studies occurring in 74% of cases. Despite the differences in mechanism of injury, physical examination is sensitive and effective in predicting which patients will have negative angiographic studies after each of the three forms of trauma.
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