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Noninvasive Vascular Testing in the Trauma Patient

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Noninvasive Vascular Diagnosis

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Abstract

For decades, the management of traumatic vascular injuries to the extremity has challenged surgeons. During the times of conflict for this country, surgeons faced an inordinate amount of mangled extremities, and as a result patient evaluation and surgical techniques were advanced. This benefited not only military personnel but eventually translated to improve care of civilian trauma victims. Parallel to the course of surgery with movement toward minimally invasive techniques, the diagnosis of vascular trauma has progressed from an invasive angiography, resulting in low yielding surgical exploration, to a selective, noninvasive diagnostic paradigm. Physical exam alone lacks the sensitivity to identify patients with clinically significant vascular injury. Measurement of ankle-brachial systolic pressure index was paramount in aiding clinicians to further identify trauma patients who would benefit from further diagnostic investigations or observation. Duplex ultrasound scanning has improved the accuracy for patient evaluation for extremity vascular injury. This technique, available in trauma centers, requires examiner and physician interpreter experience, and portable capability, to be useful in the emergency room. In the multisite trauma, especially following blunt injury, computerized tomography angiography has emerged as a preferred diagnostic modality. Other arterial techniques, such as magnetic resonance angiography and intravascular ultrasound, are used for patient- and injury-specific indications. In this chapter, the application of noninvasive vascular testing is detailed for the diagnostic evaluation of patients with suspected or known extremity vascular injury.

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Author information

Authors and Affiliations

  1. Vascular Surgery, Keck Medical Center of USC, Los Angeles, CA, USA

    Josefina A. Dominguez MD

  2. Vascular Surgery, Keck School of Medicine, 1520 San Pablo St., Suite 4300, Los Angeles, CA, 90033, USA

    Vincent Lopez Rowe MD

  3. Division of Vascular Surgery, Department of Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA

    Fred A. Weaver MD, FACS

Authors
  1. Josefina A. Dominguez MD
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  2. Vincent Lopez Rowe MD
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  3. Fred A. Weaver MD, FACS
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Corresponding author

Correspondence to Vincent Lopez Rowe MD .

Editor information

Editors and Affiliations

  1. Charleston, West Virginia, USA

    Ali F. AbuRahma

Review Questions

Review Questions

  1. 1.

    Which of the following is NOT a “hard sign” of extremity vascular injury?

    1. a.

      Pulsatile external bleeding

    2. b.

      Expanding hematoma

    3. c.

      Localized soft tissue mass

    4. d.

      Absent distal pulses

  2. 2.

    Which of the following diagnostic modalities is most frequently used in the emergency department when extremity artery injury is suspected?

    1. a.

      Duplex ultrasound

    2. b.

      Ankle-brachial systolic pressure index

    3. c.

      CT angiogram

    4. d.

      MR angiogram

  3. 3.

    The major limitation of CT angiography in the evaluation of the vascular trauma patient is:

    1. a.

      Contrast-induced nephrotoxicity

    2. b.

      Artery wall calcification

    3. c.

      Bone fragments

    4. d.

      Time of acquisition

Answer Key

  1. 1.

    c

  2. 2.

    b

  3. 3.

    a

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Dominguez, J.A., Rowe, V.L., Weaver, F.A. (2017). Noninvasive Vascular Testing in the Trauma Patient. In: AbuRahma, A. (eds) Noninvasive Vascular Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-54760-2_35

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  • DOI: https://doi.org/10.1007/978-3-319-54760-2_35

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  • Online ISBN: 978-3-319-54760-2

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