The success of duplex ultrasonographic scanning in diagnosis of extremity vascular proximity trauma
W. R. Fry, R. S. Smith, D. V. Sayers, V. J. Henderson, D. J. Morabito, E. K. Tsoi, J. K. Harness and C. H. Organ Jr
Department of Surgery, University of California, Davis-East Bay.
OBJECTIVE: To determine if duplex ultrasonographic scanning is
diagnostically equivalent to arteriography and/or operative exploration in
the diagnosis of extremity vascular proximity trauma. DESIGN: A prospective
evaluation comparing duplex scanning with arteriography or operative
exploration in 50 patients. Subsequently, duplex scanning was used alone
for 175 extremity vascular proximity injuries, with other diagnostic
methods used when injury was indicated on the duplex scan. SETTING: A busy
urban trauma center. PATIENTS: Consecutive sample of 200 patients with 225
extremity injuries. SELECTION CRITERIA: Vascular proximity injury or
diminished strength of the extremity pulse. MAIN OUTCOME MEASURES: The
presence or absence of vascular proximity injury confirmed on angiography
and/or operative exploration. RESULTS: Duplex scanning had 100% sensitivity
and 100% specificity compared with arteriography and/or operative
exploration in the first 50 cases. In the remaining 175 cases of extremity
trauma, vascular injuries were diagnosed with duplex scanning alone. Duplex
scanning detected 18 injuries, 17 of which were confirmed by correlation
with arteriograms and/or operative exploration. One false-positive
result--spasm of the superficial femoral artery--was found on
arteriography. Seven unsuspected venous injuries were also diagnosed.
CONCLUSIONS: Duplex scanning is a noninvasive, safe, effective method for
the initial evaluation of potential extremity vascular proximity injury. It
has replaced arteriography in the initial diagnosis of extremity vascular
proximity trauma by our trauma service.
