Exclusion angiography for patients with possible vascular injuries of the extremities--a better use of trauma center resources.

In this study we evaluated the capacity of selective angiography to reduce the number of exploratory procedures with negative results for suspected peripheral vascular injury. During the 4-year period ending December 1982, 316 trauma patients were evaluated for possible vascular injuries of the extremities. Exploration alone was performed for 124 patients, and 61 had vascular injuries; 192 patients were considered to be in stable condition and underwent selective angiography. Of these, 50 had vascular injuries and required operation. There were two false positive angiograms and one false negative angiogram (missed arteriovenous fistula). The overall diagnostic accuracy for angiography was 98%. The overall positive yield rate for operation was 64%. Selective angiography for the stable trauma patient to exclude vascular injury is safe, sensitive, and specific. Exclusion angiography has increased the overall positive yield rate for exploration of suspected vascular injury at our institution by 49%. Thus the selective use of exclusion angiography for patients who are stable and who do not have other indications for wound exploration is a reasonable and necessary mode of diagnosis for more effective use of operating room facilities.