The use of CTA is associated with lower morbidity than that of selective arteriography and has resulted in a precipitous decrease in negative surgical exploration rates in the post-traumatic Nonatherosclerotic Peripheral Arterial Disease patient [43]. One study has suggested that the critical time saved by CTA in diagnosing lower-extremity vascular injury translates to decreased morbidity, thereby reducing hospital costs while improving outcomes [34]. MRA Lower Extremity MRA is not indicated after trauma, as long requisite imaging times are precarious in a potentially unstable patient. Underlying shrapnel or bullet fragments pose significant safety concerns within the confines of the magnetic field, in addition to degrading image quality [43]. Arteriography Lower Extremity Arteriography is recommended for vascular evaluation in patients with hard signs of vascular injury requiring immediate repair [44,45]. This can be done in the operating room with a C-arm or in a hybrid suite [44,45]. Selective arteriography is invasive and unable to depict extravascular anatomy [34]. In addition, it is time- consuming and could delay treatment of other traumatic injuries. However, it accurately detects active bleeding, pseudoaneurysms, arteriovenous fistula, and vascular thrombosis. A recent retrospective review advocates the use of arteriography if CTA is equivocal [43]. US Duplex Doppler Lower Extremity While portability and lack of nephrogenic contrast administration make US duplex Doppler an attractive option for evaluating the lower-extremity vessels after trauma, significant injury to the superficial soft tissues may limit its accuracy in assessing vascular integrity [43]. A recent meta-analysis reported that the post-test probability of arterial injury was 89% with a positive US and 5% with a negative US [46]. US Intravascular Lower Extremity There is no relevant literature regarding the use of IVUS in the evaluation of lower-extremity vascular trauma.
Nonatherosclerotic Peripheral Arterial Disease. The use of CTA is associated with lower morbidity than that of selective arteriography and has resulted in a precipitous decrease in negative surgical exploration rates in the post-traumatic Nonatherosclerotic Peripheral Arterial Disease patient [43]. One study has suggested that the critical time saved by CTA in diagnosing lower-extremity vascular injury translates to decreased morbidity, thereby reducing hospital costs while improving outcomes [34]. MRA Lower Extremity MRA is not indicated after trauma, as long requisite imaging times are precarious in a potentially unstable patient. Underlying shrapnel or bullet fragments pose significant safety concerns within the confines of the magnetic field, in addition to degrading image quality [43]. Arteriography Lower Extremity Arteriography is recommended for vascular evaluation in patients with hard signs of vascular injury requiring immediate repair [44,45]. This can be done in the operating room with a C-arm or in a hybrid suite [44,45]. Selective arteriography is invasive and unable to depict extravascular anatomy [34]. In addition, it is time- consuming and could delay treatment of other traumatic injuries. However, it accurately detects active bleeding, pseudoaneurysms, arteriovenous fistula, and vascular thrombosis. A recent retrospective review advocates the use of arteriography if CTA is equivocal [43]. US Duplex Doppler Lower Extremity While portability and lack of nephrogenic contrast administration make US duplex Doppler an attractive option for evaluating the lower-extremity vessels after trauma, significant injury to the superficial soft tissues may limit its accuracy in assessing vascular integrity [43]. A recent meta-analysis reported that the post-test probability of arterial injury was 89% with a positive US and 5% with a negative US [46]. US Intravascular Lower Extremity There is no relevant literature regarding the use of IVUS in the evaluation of lower-extremity vascular trauma.