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首页> 外文期刊>Annals of vascular surgery >Computed tomographic angiography as the primary diagnostic modality in penetrating lower extremity vascular injuries: a level I trauma experience.
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Computed tomographic angiography as the primary diagnostic modality in penetrating lower extremity vascular injuries: a level I trauma experience.

机译：计算机体层摄影血管造影作为穿透下肢血管损伤的主要诊断手段：I级创伤经历。

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BACKGROUND: Computed tomographic angiography (CTA) has been established as a valid modality for the assessment of extremity vascular injury. Over the last several years at our institution, CTA has evolved as the primary diagnostic modality for penetrating extremity injuries, largely replacing diagnostic angiography. The purpose of this study was to evaluate the outcomes with this imaging modality at a high-volume Level I trauma center. METHODS: A retrospective review was conducted of all patients presenting with penetrating lower extremity trauma between 2008 and 2009. Patient factors collected included demographics, mechanism of injury, injury severity, presence of hard signs of vascular injury, radiologic studies, operative intervention, and outcomes. RESULTS: There were 132 patients with penetrating lower extremity trauma. The average age of the patients was 25 years, with an average injury severity score of 10. The injuries were primarily gunshot wounds (89%). In all, 59 patients (45%) underwent CTA. CTA of the extremity was performed as a continuation of a computed tomography of the chest/abdomen/pelvis in 28 (47%) versus a targeted CTA of the extremity in 31 (53%) patients. In all, 34 (58%) CTAs were negative for vascular injury, 19 (32%) were positive, and six (10%) were indeterminate. Of the 34 patients with a normal CTA, none went to the operating room for repair of a major vascular injury; similarly, of the 19 patients with an abnormal CTA, there were no negative operative explorations. A total of 28 (21%) patients required operative intervention for the injured extremity; procedures performed included fasciotomy, venous and arterial ligation, primary repair, and interposition grafting. There were no amputations and no mortalities. CONCLUSIONS: Our results support the use of CTA as the primary imaging modality in evaluating penetrating lower extremity injury. Because of its proven accuracy in detecting major vascular injury, cost-effectiveness, and ease and rapidity of administration and interpretation, CTA should supplant conventional angiography in initial evaluation of the patient presenting with penetrating trauma.
机译：背景：计算机断层血管造影（CTA）已被确立为评估四肢血管损伤的一种有效方式。在我们机构的过去几年中，CTA已经发展成为穿透四肢损伤的主要诊断手段，在很大程度上取代了诊断性血管造影术。这项研究的目的是在大量I级创伤中心评估这种影像学检查的结果。方法：回顾性分析2008年至2009年间所有下肢穿透性创伤的患者。收集的患者因素包括人口统计学，损伤机制，损伤严重程度，血管损伤的硬体征，影像学检查，手术干预和结果。结果：有132例穿透性下肢创伤。患者的平均年龄为25岁，平均伤害严重度评分为10。伤害主要是枪伤（89％）。共有59例患者（45％）接受了CTA。在连续进行胸部/腹部/骨盆计算机断层扫描的28位患者（47％）中进行了四肢CTA检查，而在31位患者（53％）中进行了四肢目标CTA检查。共有34例（58％）CTA血管损伤阴性，19例（32％）阳性，6例（10％）不确定。在CTA正常的34例患者中，没有人去手术室修复严重的血管损伤。同样，在19位CTA异常的患者中，没有进行阴性手术探查。共有28名（21％）患者需要对肢体受伤进行手术干预;进行的程序包括筋膜切开术，静脉和动脉的结扎，初步修复和介入移植。没有截肢和死亡。结论：我们的结果支持使用CTA作为评估穿透性下肢损伤的主要影像学手段。由于其在检测主要血管损伤方面的准确度，成本效益以及给药和解释的简便快捷，CTA在出现穿透性创伤的患者的初步评估中应取代传统的血管造影术。

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