Learning objectives
Explain the CT angiography technique and protocols in vascular trauma of the extremities.
Review the normal arterial anatomy of the upper and lower limbs.
Describe findings of arterial injuries of the extremities in trauma patients.
Know the potential pitfalls when interpreting an angio-CT of the extremities.
Background
Revision of the literature of vascular lesions of the extremities in the traumatic patients.
Illustrate the spectrum of imaging findings on computed tomography in trauma patients.
Findings and procedure details
Trauma is the leading cause of death in patients under 45 years and the third leading cause of death. Up to 1% of all trauma injuries have a vascular component, involving mainly the extremities.
CT angiography (CTA) of the extremities is a rapid, cost-effective, and noninvasive technique that has widely replaced digital subtraction angiography DSA. It allows rapid characterization of traumatic arterial lesions. Meta-analysis studies have shown very high sensitivity and specificity of 96,2% and 99,2%, respectively, for detecting clinically significant arterial injury.
Other techniques...
Conclusion
The high sensitivity and speed of modern CT make it an optimal imaging technique to identify and characterize suspected vascular injuries.
Identification of arterial injury signs is essential to prevent vascular injury complications and help in the management of the patients.
Patients with negative CTA for vascular lesions do not require vascular intervention, which supports extremity CTA's utility to exclude clinically relevant vascular injury.
Personal information and conflict of interest
Z. H. Chen Zhou:
Nothing to disclose
E. MARTINEZ CHAMORRO:
Nothing to disclose
L. Ibañez Sanz:
Nothing to disclose
S. Borruel Nacenta:
Nothing to disclose
V. S. Gerónimo Aguilar:
Nothing to disclose
R. Sanz De Lucas:
Nothing to disclose
References
Refky Nicola, Don Kawakyu-O´Connor, Mariano Scalgione. Imaging of Vascular Injuries of the Extremities. Semin Musculoskelet Radiol 2017;21:336–348.
Charles G Colip, Varun Gorantla, Christina A LeBdis, Jorge A Soto, Stephan W Anderson. Extremity CTA for penetrating trauma: 10-year experience using a 64-detector row CT scanner. Emerg Radiol 2017 Jun;24(3):223-232.
Mandip S. Gakhal and Kamyar A. Sartip. CT Angiography Signs of Lower Extremity Vascular Trauma. AJR Am J Roentgenol2009 Jul;193(1): W49-57.
Michelle M Miller-Thomas, O Clark West, Alan M Cohen. Diagnosing Traumatic Arterial Injury in the Extremities...