J Korean Fract Soc.  2012 Jan;25(1):26-30. 10.12671/jkfs.2012.25.1.26.

Is CT Angiography a Reliable Tool for Diagnosis of Traumatic Vessel Injury in the Lower Extremities?

• Park JH
• Lee KB
• Park H
• Lee JM

• KMID: 1434107
• DOI: http://doi.org/10.12671/jkfs.2012.25.1.26

Abstract

PURPOSE
Computed tomographic (CT) angiography is the first choice of diagnosis in traumatic vessel injury in the lower extremities, replacing angiography. The purpose of this study was to investigate the clinical reliability of CT angiography through a retrospective study.
MATERIALS AND METHODS
Seventeen patients underwent CT angiography before surgery for traumatic vessel injury in the lower extremities from 2009 to 2010, and a comparative analysis of operative findings in all patients with a positive predictive value and sensitivity were measured.
RESULTS
In all patients, 16 artery ruptures and 1 compartment syndrome occurred. In 15 artery ruptures, preoperative findings of CT angiography and surgical findings were consistent, and the positive predictive value was 93.8%. One patient with posterior tibial artery rupture was revealed as normal in CT angiography; thus, sensitivity was 93.8% (15/16 patients), and the accuracy rate was 88.2% (15/17 patients).
CONCLUSION
Though CT angiography is a reliable tool for diagnosis in traumatic vessel injury in the lower extremities, a more invasive test will be needed, especially peripheral angiography or diagnostic exploration, in cases of relatively small vessel injuries around the ankle or compartment syndrome because of low accuracy.

Keyword

CT angiography; Traumatic vessel injury; Screening test

MeSH Terms

Angiography
Animals
Ankle
Arteries
Compartment Syndromes
Glycosaminoglycans
Humans
Lower Extremity
Retrospective Studies
Rupture
Tibial Arteries
Glycosaminoglycans

Figure

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  Fig. 1 Case 17. (A) Plain radiogram shows the comminuted fracture on both femur and tibia shaft. (B) CT angiography shows soft tissue and muscle swelling on femoral supracondylar area. (C) CT angiography reveals the abrupt disruption of popliteal artery in the knee area, however, there is no vessel injury in intraoperative finding.

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  Fig. 2 Case 12. (A) Plain radiogram shows comminuted ankle fracture. (B) CT angiography shows that there is no definite vessel injury except the weak patency of dye in the posterior tibial artery.

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