Utility of computed tomography angiography in traumatic lower limb injury: Review of clinical impact in level 1 trauma centre

• Published in: Injury 2021-10, Vol.52 (10), p.3064-3067
• Main Authors: Joseph, Timothy I., Ratnakanthan, Prasanna J., Paul, Eldho, Clements, Warren
• Format: Article
• Language: English
• Subjects: Angiography; Leg injuries; Lower extremity; Tomography; Vascular system injuries; X-ray computed
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2021.02.047

•CT leg angiography is commonly used in trauma imaging to assess for the presence of vascular injury. This study demonstrates that, in the absence of hard or soft signs of vascular injury, CT angiography revealed no vascular injury requiring intervention.•If hard or soft signs of vascular injury are present, CT angiography is reasonably (7.4%) correlated with need for intervention with regard to vascular injury. CT angiography (CTA) is efficient and accurate in detecting lower limb vascular injury in the setting of trauma (1-6). Less clear is the in-practice correlation between appropriate indications for these examinations and subsequent clinical impacts. All CT leg angiography acquired from January 2016 through April 2019 were reviewed via retrospective search. Studies not acquired for trauma were excluded. Imaging and reports were reviewed to assess for vascular injury. Electronic medical records were reviewed to assess the presence or absence of classical ‘hard’ or ‘soft’ signs of vascular injury and whether vascular intervention was undertaken. A total of 347 lower limb injuries were identified in 273 men and 74 women. Mean age was 41.5 years ranging from 15-95 years. 268 cases were fractures with 177 open injuries. 301 of injuries were secondary to blunt trauma, 31 penetrating injury occurred and 15 cases were ascribed to blast/gunshot injury. 74 (21.3%) studies were deemed to have a positive finding of vascular injury, 249 (71.8%) were reported as negative and 24 (6.9%) were indeterminate. Of the cases with positive findings, 26 underwent intervention (7.4% of all patients undergoing CTA). No patients with negative CTA required intervention, while three (3, 0.8% of total) with indeterminate findings required intervention. Where there were no clinical signs (absence of any hard or soft signs) 249 CTA's were performed and none required any form of intervention. In the absence of clinical signs of vessel injury, CT angiography is unlikely to demonstrate vascular injury requiring intervention in the setting of lower limb trauma.