The utility of color flow Doppler examination in penetrating extremity arterial trauma.

Recent reports from our institution have demonstrated the safety of nonoperative management of minimal arterial injuries. The purpose of this pilot study was to evaluate whether color flow Doppler (CFD) examination could detect minimal arterial injuries caused by penetrating extremity trauma. Twelve patients with minimal arterial injuries identified by arteriography were treated nonoperatively. Each also underwent color flow examination. Seven of 12 arteriographic abnormalities were detected by color flow examination. Two intimal injuries (brachial artery, superficial femoral artery (SFA)), one small (1 mm) pseudoaneurysm (popliteal artery), and two minor vessel occlusions (interosseous artery, branch off SFA) were not detected. These preliminary data suggest that color flow scans may be less sensitive than arteriography in the detection of clinically insignificant lesions such as small intimal defects or small vessel occlusions. Despite this, CFD examination was successful in detecting more significant lesions such as pseudoaneurysms, arteriovenous fistulae, and major vessel occlusions. This is relevant since these lesions may require immediate intervention. These findings suggest the possibility that color Doppler sonography may be able to sequentially monitor these lesions to determine if they resolve or progress. If progression is documented they may require surgical correction. Further prospective studies must be performed to assess whether color flow Doppler examination can supplant arteriography in patients at low or intermediate risk for arterial injury following penetrating arterial trauma.