Emergency trauma angiography: accuracy, safety, and pitfalls

The accuracy, safety, pitfalls, and limitations of trauma angiography were determined by comparing the findings of 280 arteriograms performed for suspected arterial trauma with the patients' surgical findings and clinical courses. Trauma angiography was accurate, with a sensitivity for detecting major arterial injury of 98.3%, specificity of 98.5%, positive predictive value of 95.0%, and negative predictive value of 99.5%. Angiography was effective in eliminating the need for surgical arterial exploration in 203 cases (73%). These emergency procedures were associated with a 5% morbidity; all complications were minor. Sixteen percent of the studies were technically compromised. Common factors included poor vessel opacification with aortic contrast injection, over-penetrated films, mistimed lower extremity studies, and overlapped structures obscuring the vessels. In most cases, the field of study can be limited to a region 5 cm beyond the most distant fracture fragment, bullet fragment, and entrance or exit wound. Emergency trauma angiography is an ideal technique for evaluating injured patients with suspected arterial trauma. It is safe to perform and accurately separates patients who may be spared surgical exploration from those who require vascular intervention.