Emergency center arteriography in the evaluation of suspected peripheral vascular injuries in children

• Published in: Journal of pediatric surgery Vol. 28; no. 5; pp. 677 - 680
• Main Authors: Itani, Kamal M.F., Rothenberg, Steven S., Brandt, Mary L., Burch, Jon M., Mattox, Kenneth L., Harberg, Franklin J., Pokorny, William J.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.05.1993; Elsevier
• Subjects: Adolescent; Angiography; Arteries - injuries; Biological and medical sciences; Child; Child, Preschool; Diatrizoate Meglumine; Emergency Medical Services; Extremities - blood supply; Extremities - injuries; Female; Humans; Male; Medical sciences; Sensitivity and Specificity; Traumas. Diseases due to physical agents; Vascular injuries: limbs, aorta, vena cava; Wounds and Injuries - diagnostic imaging; Wounds and Injuries - etiology; Arteriography, emergency center; peripheral vascular injuries, children; Human; Performance evaluation; Vascular disease; Radiodiagnosis; Cardiovascular disease; Exploration; End; Arteriography; Emergency; Child; Trauma
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/0022-3468(93)90030-O

During the 6-year period from 1983 to 1989, 109 children aged 3 to 18 years (mean, 16) with suspected peripheral vascular injuries underwent 113 emergency center arteriograms (ECA) performed by hand injection of contrast material using a single roentgenographic film. The most common indication for ECA was the proximity of the injury in 93 (82.3%) of the cases as penetrating injury accounted for 106 (94%) of the cases. There were 89 true-negative, 14 truepositive, 1 false-negative, and no false-positive arteriograms. The remaining 9 arteriograms were either equivocal or technically inadequate. The sensitivity, specificity, and diagnostic accuracy of this procedure were 98.9%, 100%, and 91.2%, respectively. Operative intervention was required for 9 (64.2%) injuries detected by emergency arteriography. The remaining 5 injuries were considered minor and were observed with no complications during a period of 21 months. Sixty-eight children (76.4%) with negative ECA were followed for a mean of 12 months with no vascular complications or growth abnormalities noted. ECA is a rapid, accurate, and cost-effective technique. It is of particular value in detecting the presence of occult arterial injuries that might have deleterious effects in the growing child.