St George's Vascular Institute, St George's University of London, London, UK.
Br J Surg. 2012 Apr;99(4):494-505. doi: 10.1002/bjs.7763. Epub 2011 Dec 22.
Over the past 50 years the management of vascular trauma has changed from mandatory surgical exploration to selective non-operative treatment, where possible. Accurate, non-invasive, diagnostic imaging techniques are the key to this strategy. The purpose of this review was to define optimal first-line imaging in patients with suspected vascular injury in different anatomical regions.
A systematic review was performed of literature relating to radiological diagnosis of vascular trauma over the past decade (2000-2010). Studies were included if the main focus was initial diagnosis of blunt or penetrating vascular injury and more than ten patients were included.
Of 1511 titles identified, 58 articles were incorporated in the systematic review. Most described the use of computed tomography angiography (CTA). The application of duplex ultrasonography, magnetic resonance imaging/angiography and transoesophageal echocardiography was described, but significant drawbacks were highlighted for each. CTA displayed acceptable sensitivity and specificity for diagnosing vascular trauma in blunt and penetrating vascular injury within the neck and extremity, as well as for blunt aortic injury.
Based on the evidence available, CTA should be the first-line investigation for all patients with suspected vascular trauma and no indication for immediate operative intervention.
在过去的 50 年中，血管创伤的治疗策略已经从强制性手术探查转变为尽可能选择非手术治疗。准确、无创的诊断影像学技术是实现这一策略的关键。本综述的目的是确定在不同解剖区域疑似血管损伤患者中首选的一线影像学检查方法。
对过去十年（2000-2010 年）与血管创伤放射学诊断相关的文献进行了系统回顾。如果主要焦点是钝性或穿透性血管损伤的初始诊断，并且纳入了 10 例以上患者，则纳入研究。
在 1511 个标题中，有 58 篇文章被纳入系统评价。大多数文章描述了计算机断层血管造影（CTA）的应用。还描述了双功能超声、磁共振成像/血管造影和经食管超声心动图的应用，但每种方法都存在明显的局限性。CTA 显示出在颈部和四肢的钝性和穿透性血管损伤以及钝性主动脉损伤中诊断血管创伤的可接受的敏感性和特异性。
根据现有证据，CTA 应该是所有疑似血管创伤且无立即手术干预指征的患者的首选一线检查方法。
