Multi-slice CT angiography for arterial evaluation in the injured lower extremity

Kenji Inaba, Jennifer Potzman, Felipe Munera, Mark McKenney, Rogelio Munoz, Luis Rivas, Michael Dunham, Joseph DuBose, Eric R. Frykberg, John Bilello

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

Background: With the evolution of multi-slice helical computed tomographic angiography (MCTA), the optimal imaging modality for arterial injury in the traumatized lower extremity has been challenged. The objective of this study was to evaluate the ability of MCTA to detect arterial injury in the traumatized lower extremity. Our hypothesis was that MCTA is a sensitive and specific test for the non-invasive evaluation of lower extremity arterial injury. Methods: After Institutional Review Board approval, we reviewed all patients at our Level I trauma center who sustained lower extremity trauma and underwent initial evaluation by MCTA over a 3-year period ending in February 2005. MCTA accuracy was tested against a gold standard of operative intervention, duplex ultrasonography, catheter-based angiography, or clinical follow-up. Results: Sixty-three MCTAs were performed in 59 patients. MCTA was diagnostic in 62 of the 63 scans (98.4%). The mechanism was penetrating in 45.8%. Lower extremity fractures were present in 38.7% of patients studied. There were 22 positive studies. Out of this group, 19 were confirmed at operation and 3 were managed non-operatively. In the 19 injuries confirmed in the operating theater, there were 5 superficial femoral, 2 profunda, 10 popliteal, 1 posterior tibial, and 1 injury to all 3 mid-calf arteries. There were two injuries below the trifurcation managed non-operatively and there was one popliteal occlusion with distal reconstitution that was confirmed by duplex and managed non-operatively because of patient refusal of surgery. Forty studies were negative for arterial injury, with clinical follow up available in 89.5%, for a mean of 48.2 days (range, 5-287 days). No missed injuries were identified during the follow-up period. MCTA was non-diagnostic in 1 patient (1.6%), secondary to artifact from retained missile fragments. MCTA achieved 100% sensitivity and 100% specificity in detecting clinically significant arterial injury. Conclusion: MCTA is a sensitive and specific non-invasive imaging modality for arterial evaluation in the injured lower extremity that may replace catheter-based angiography in most patients.

Original languageEnglish
Pages (from-to)502-507
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume60
Issue number3
DOIs
StatePublished - Mar 1 2006

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Lower Extremity
Angiography
Wounds and Injuries
Computed Tomography Angiography
Catheters
Trauma Centers
Research Ethics Committees
Thigh
Artifacts
Ultrasonography
Arteries
Sensitivity and Specificity

Keywords

  • Arteries
  • Computed tomography
  • Diagnostic imaging
  • Injuries
  • Lower Limb
  • Radiography
  • Wounds

ASJC Scopus subject areas

  • Surgery

Cite this

Multi-slice CT angiography for arterial evaluation in the injured lower extremity. / Inaba, Kenji; Potzman, Jennifer; Munera, Felipe; McKenney, Mark; Munoz, Rogelio; Rivas, Luis; Dunham, Michael; DuBose, Joseph; Frykberg, Eric R.; Bilello, John.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 60, No. 3, 01.03.2006, p. 502-507.

Research output: Contribution to journalArticle

Inaba, K, Potzman, J, Munera, F, McKenney, M, Munoz, R, Rivas, L, Dunham, M, DuBose, J, Frykberg, ER & Bilello, J 2006, 'Multi-slice CT angiography for arterial evaluation in the injured lower extremity', Journal of Trauma - Injury, Infection and Critical Care, vol. 60, no. 3, pp. 502-507. https://doi.org/10.1097/01.ta.0000204150.78156.a9
Inaba, Kenji ; Potzman, Jennifer ; Munera, Felipe ; McKenney, Mark ; Munoz, Rogelio ; Rivas, Luis ; Dunham, Michael ; DuBose, Joseph ; Frykberg, Eric R. ; Bilello, John. / Multi-slice CT angiography for arterial evaluation in the injured lower extremity. In: Journal of Trauma - Injury, Infection and Critical Care. 2006 ; Vol. 60, No. 3. pp. 502-507.
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abstract = "Background: With the evolution of multi-slice helical computed tomographic angiography (MCTA), the optimal imaging modality for arterial injury in the traumatized lower extremity has been challenged. The objective of this study was to evaluate the ability of MCTA to detect arterial injury in the traumatized lower extremity. Our hypothesis was that MCTA is a sensitive and specific test for the non-invasive evaluation of lower extremity arterial injury. Methods: After Institutional Review Board approval, we reviewed all patients at our Level I trauma center who sustained lower extremity trauma and underwent initial evaluation by MCTA over a 3-year period ending in February 2005. MCTA accuracy was tested against a gold standard of operative intervention, duplex ultrasonography, catheter-based angiography, or clinical follow-up. Results: Sixty-three MCTAs were performed in 59 patients. MCTA was diagnostic in 62 of the 63 scans (98.4{\%}). The mechanism was penetrating in 45.8{\%}. Lower extremity fractures were present in 38.7{\%} of patients studied. There were 22 positive studies. Out of this group, 19 were confirmed at operation and 3 were managed non-operatively. In the 19 injuries confirmed in the operating theater, there were 5 superficial femoral, 2 profunda, 10 popliteal, 1 posterior tibial, and 1 injury to all 3 mid-calf arteries. There were two injuries below the trifurcation managed non-operatively and there was one popliteal occlusion with distal reconstitution that was confirmed by duplex and managed non-operatively because of patient refusal of surgery. Forty studies were negative for arterial injury, with clinical follow up available in 89.5{\%}, for a mean of 48.2 days (range, 5-287 days). No missed injuries were identified during the follow-up period. MCTA was non-diagnostic in 1 patient (1.6{\%}), secondary to artifact from retained missile fragments. MCTA achieved 100{\%} sensitivity and 100{\%} specificity in detecting clinically significant arterial injury. Conclusion: MCTA is a sensitive and specific non-invasive imaging modality for arterial evaluation in the injured lower extremity that may replace catheter-based angiography in most patients.",
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AU - Inaba, Kenji

AU - Potzman, Jennifer

AU - Munera, Felipe

AU - McKenney, Mark

AU - Munoz, Rogelio

AU - Rivas, Luis

AU - Dunham, Michael

AU - DuBose, Joseph

AU - Frykberg, Eric R.

AU - Bilello, John

PY - 2006/3/1

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N2 - Background: With the evolution of multi-slice helical computed tomographic angiography (MCTA), the optimal imaging modality for arterial injury in the traumatized lower extremity has been challenged. The objective of this study was to evaluate the ability of MCTA to detect arterial injury in the traumatized lower extremity. Our hypothesis was that MCTA is a sensitive and specific test for the non-invasive evaluation of lower extremity arterial injury. Methods: After Institutional Review Board approval, we reviewed all patients at our Level I trauma center who sustained lower extremity trauma and underwent initial evaluation by MCTA over a 3-year period ending in February 2005. MCTA accuracy was tested against a gold standard of operative intervention, duplex ultrasonography, catheter-based angiography, or clinical follow-up. Results: Sixty-three MCTAs were performed in 59 patients. MCTA was diagnostic in 62 of the 63 scans (98.4%). The mechanism was penetrating in 45.8%. Lower extremity fractures were present in 38.7% of patients studied. There were 22 positive studies. Out of this group, 19 were confirmed at operation and 3 were managed non-operatively. In the 19 injuries confirmed in the operating theater, there were 5 superficial femoral, 2 profunda, 10 popliteal, 1 posterior tibial, and 1 injury to all 3 mid-calf arteries. There were two injuries below the trifurcation managed non-operatively and there was one popliteal occlusion with distal reconstitution that was confirmed by duplex and managed non-operatively because of patient refusal of surgery. Forty studies were negative for arterial injury, with clinical follow up available in 89.5%, for a mean of 48.2 days (range, 5-287 days). No missed injuries were identified during the follow-up period. MCTA was non-diagnostic in 1 patient (1.6%), secondary to artifact from retained missile fragments. MCTA achieved 100% sensitivity and 100% specificity in detecting clinically significant arterial injury. Conclusion: MCTA is a sensitive and specific non-invasive imaging modality for arterial evaluation in the injured lower extremity that may replace catheter-based angiography in most patients.

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KW - Computed tomography

KW - Diagnostic imaging

KW - Injuries

KW - Lower Limb

KW - Radiography

KW - Wounds

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