The Role of Angiography in Periclavicular Penetrating Trauma

Gonzalez, Richard P.; Falimirski, Mark E.
August 1999
American Surgeon;Aug1999, Vol. 65 Issue 8, p711
Academic Journal
Our objective was to evaluate whether physical examination in conjunction with chest X-ray can accurately diagnose the presence of significant vascular injury in penetrating periclavicular trauma. Results from a management protocol for penetrating periclavicular trauma were reviewed for the period January 1992 through December 1996 at an urban Level I trauma center. All patients requiting angiography for periclavicular penetrating trauma with trajectory of the injury falling between the lateral border of the manubrium and the anterior axillary line were entered into the management protocol. All patients underwent anterior-posterior chest radiography on arrival to the trauma center and 6 hours after admission. Tube thoracostomy was placed if clinically indicated on presentation or for X-ray findings. Clinical assessment was performed on all patients, with emphasis placed on the presence of "hard" signs for vascular injury. In addition to accepted hard signs for vascular injury, significant chest tube output (>1000 cc) and chest X-ray findings consistent with significant hemorrhage were also considered hard signs for vascular injury. Assuming hemodynamic stability, all patients with suspected subclavian/axillary arterial injury based on wound trajectory or clinical findings consistent with vascular injury underwent angiography. Forty-six patients were entered into the protocol with 30 left-sided injuries and 16 right sided injuries. The majority of injuries were secondary to gunshot wounds (31), with 14 stab wounds and 1 shotgun injury. Emergency room chest X-ray results revealed 32 negative chest X-rays, 7 pneumothoraces, 2 hemopneumothoraces, 2 hemo-thoraces, and 3 chest tubes placed before initial chest X-ray. A total of 7 injuries were diagnosed, with 1 missed injury, resulting in a sensitivity of 86 per cent for clinical assessment. The missed injury was a pseudoaneurysm of an axillary artery secondary to a self-inflicted shotgun wound. One mortality occurred ..


Related Articles

  • Evaluation of Vascular Injury in Penetrating Extremity Trauma: Angiographers Stay Home. Conrad, Mark F.; Patton Jr., Joe H.; Parikshak, Manesh; Kralovich, Kurt A. // American Surgeon;Mar2002, Vol. 68 Issue 3, p269 

    The debate over the use of diagnostic angiography (DA) to exclude arterial injury in penetrating extremity trauma (PET) continues. This review evaluates our current protocol for PET and identifies indications for DA. Patients presenting to our urban Level I trauma center between January 1997 and...

  • The imaging of stab injuries. de Vries, Coert S.; Africa, Mogoeemang; Gebremariam, Fekade A.; van Rensburg, J. Janse; Otto, Susan F.; Potgieter, Henrik F. // Acta Radiologica;Jan2010, Vol. 51 Issue 1, p92 

    In the trauma unit of the Bloemfontein Academic Complex, the total number of stab wounds seen represents approximately 70.5% of penetrating injuries, which is 6.4% of 5004 trauma cases seen in a period of 1 year. The other cases are gunshot wounds and pedestrian or motor vehicle accidents....

  • A Reappraisal of Exclusion Angiography in Gunshot Wounds of the Extremities. Luks, Francois I.; Picard, Daniel L.; Pizzi, Walter F.; Battaglia, Steven A.; LaMaute, Henry R. // Vascular Surgery;May1991, Vol. 25 Issue 4, p295 

    The routine use of exclusion angiography in trauma to the extremities has resulted in varying percentages of negative studies, mostly because of a great variability in location and type of injury. The authors reviewed 117 low-velocity gunshot wounds to the extremities. Twenty-six cases presented...

  • Skip the Angio Suite: Characterize Blunt and Penetrating Vascular Injuries in the Extremities with Computed Tomography Alone. Rubin, Geoffrey D. // Vascular;Nov2005 Supplement, Vol. 13, pS79 

    The article discusses a research on the abnormalities encountered when performing computed tomography angiography of the extremities for the assessment of arterial injuries owing to blunt and penetrating trauma. Some consequences or complications resulting from failure to diagnose arterial...

  • Inferior gluteal artery pseudoaneurysm mimicking gluteal abscess. Singh, Vikas; Sharma, Hemant; Maini, Lalit // Indian Journal of Surgery;Dec2007, Vol. 69 Issue 6, p257 

    We report a case of pseudoaneurysm of inferior gluteal artery initially diagnosed as gluteal abscess. Pseudoaneurysms of inferior gluteal artery are rare. High degree of clinical suspicion is required in a patient presenting with a post-traumatic swelling in the gluteal region. These aneurysms...

  • Management of penetrating brain injury. Kazim, Syed Faraz; Shamim, Muhammad Shahzad; Tahir, Muhammad Zubair; Enam, Syed Ather; Waheed, Shahan // Journal of Emergencies, Trauma & Shock;Jul2011, Vol. 4 Issue 3, p395 

    Penetrating brain injury (PBI), though less prevalent than closed head trauma, carries a worse prognosis. The publication of Guidelines for the Management of Penetrating Brain Injury in 2001, attempted to standardize the management of PBI. This paper provides a precise and updated account of the...

  • Preliminary analysis of the care of injured patients in33 British hospitals: first report of the United Kingdom major trauma outcome study. Yates, D.W.; Woodford, M.; Hollis, S. // BMJ: British Medical Journal (International Edition);9/26/92, Vol. 305 Issue 6856, p737 

    Examines the effectiveness of the management of major trauma in Great Britain. Measure of death and survival in hospital; Analysis of the penetrating injuries; Delays in providing experienced staff and timely operations.

  • Mediastinoscopy for the evaluation and treatment of... Faries, Peter L.; Martella, Arthur T. // American Surgeon;Dec1996, Vol. 62 Issue 12, p1073 

    Describes the use of mediastinoscopy for the evaluation of a projectile injury and concomitant removal of the projectile. Case report of a 19 year old female who sustained a gunshot wound to the right neck; Surgery performed on the patient; Information on mediastinoscopy.

  • GSW.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p990 

    An encyclopedia entry for the acronym "GSW," which refers to gunshot wound, is presented.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics