Digital subtraction angiography in extremity trauma.

Digital subtraction angiography (DSA) may have considerable impact on the work-up of patients who have suffered blunt or penetrating trauma. The angiographic evaluation of vascular injuries (e.g., arteriovenous fistulae, pseudoaneurysms, hemorrhage) can be accomplished rapidly and with minimal catheter use and manipulation, which is particularly important for those critically ill patients who have significant immobility because of multiple fractures. We retrospectively reviewed the digital subtraction angiograms in 50 consecutive cases of extremity trauma. The quality of the images in 44 of these permitted a confident diagnosis, the accuracy of which was confirmed by surgical or clinical follow-up. One false-positive and three false-negative examinations for small muscle bleeders were discovered, but none of these was considered clinically significant. DSA reduces the time required to perform the procedure, the amount of contrast material injected, patient discomfort, and film cost. Its major disadvantage is the limited field size of the image intensifier.