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William H. Snyder, III, MD; Erwin R. Thal, MD; Robert A. Bridges, MD; A. James Gerlock, MD; Malcolm O. Perry, MD; William J. Fry, MD

Arch Surg. 1978;113(4):424-428.

Abstract
• The detection of underlying arterial injury is a major problem in the management of penetrating trauma. Arteriovenous fistula and false aneurysm are late sequelae of unrepaired injuries. The diagnostic accuracy of arteriography in clinically occult injury has not been defined.

One hundred and seventy-seven patients with 183 penetrating extremity wounds underwent arteriography followed by operative vessel exploration. Arteriogram/operation correlation demonstrated 36 true-positive, 132 true-negative, 14 false-positive, and one false-negative arteriogram.

Arteriography is sufficiently sensitive to exclude the presence of arterial injury in patients with equivocal clinical signs of injury. The radiographic changes are often subtle and diagnostic accuracy demands attention to the details of technique and interpretation. Unequivocal clinical signs of arterial injury and any arteriographic abnormality are indications for operative exploration.

(Arch Surg 113:424-428, 1978)

Author Affiliations
From the Department of Surgery (Dr Snyder, Thai, Bridges, and Fry), Southwestern Medical School, the University of Texas Health Science Center, Dallas, the Department of Radiology (Dr Gerlock) Vanderbilt University Hospital, Nashville, Tenn, and the Department of Surgery (Dr Perry), the University of Washington Health Science Center, Seattle.

Footnotes
Accepted for publication Dec 12, 1977.

Read before the 85th annual meeting of the Western Surgical Association, Las Vegas, Nov 15, 1977.

Reprint requests to the Department of Surgery, University of Texas Health Science Center, 5323 Harry Hines Blvd, Dallas, TX 75235 (Dr Snyder).

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