Rose S C, Moore E E
AJR Am J Roentgenol. 1987 Sep;149(3):613-9. doi: 10.2214/ajr.149.3.613.
The arteriograms and clinical course of 280 consecutive patients with suspected arterial trauma were reviewed to correlate the angiographic abnormalities with operative findings and to assess the impact of these findings on surgical management and prognosis. Major angiographic abnormalities were found in 77 patients. Arterial occlusion (46 patients) was caused by intimal flap injury or arterial transection with subsequent thrombosis and frequently presented with an acutely ischemic extremity (27 patients, three of whom required subsequent amputations). Intraluminal defects typical for intimal flaps (20 patients) were the most difficult pathologic entity to diagnose, accounting for two false-positive angiograms and the sole false-negative examination. Focal luminal widening (five patients) corresponded with a partial-thickness injury of the arterial wall. Major angiographic extravasation of contrast material (19 patients) was caused by arterial laceration or transection and usually presented with clinical signs of acute hemorrhage; massive pelvic hemorrhage was the cause of death in three patients. Acute arteriovenous fistulas (four patients) were from arterial laceration with venous communication. Arterial narrowing with a smooth margin (50 patients) was a finding associated with a benign clinical course, except when combined with slowed arterial flow--a characteristic finding of compartment syndrome (six of 13 patients). An irregular beaded pattern of arterial narrowing (23 patients) was associated with severe injuries, subsequent poor fracture healing, and wound infection. A detailed angiographic map is of considerable value in planning surgical management. The absence of major angiographic abnormalities usually eliminates the need for surgical exploration; the location of injury and routes of distal blood flow affect the feasibility of conservative therapy; the length of occlusion influences the necessity of saphenous vein harvesting; the location of arterial extravasation determines the advisability of surgical ligation or transcatheter embolization; and the need for fasciotomy may be suggested first by the angiographic features of compartment syndrome.
回顾了连续280例疑似动脉创伤患者的动脉造影及临床病程，以将血管造影异常与手术结果相关联，并评估这些结果对手术管理及预后的影响。77例患者发现主要血管造影异常。动脉闭塞（46例患者）由内膜瓣损伤或动脉横断后继发血栓形成所致，常表现为急性肢体缺血（27例患者，其中3例随后需要截肢）。内膜瓣典型的腔内缺损（20例患者）是最难诊断的病理实体，导致2例假阳性血管造影及唯一的假阴性检查。局灶性管腔增宽（5例患者）与动脉壁的部分厚度损伤相对应。主要的造影剂血管外渗（19例患者）由动脉撕裂或横断引起，通常表现为急性出血的临床体征；3例患者死于大量盆腔出血。急性动静脉瘘（4例患者）源于动脉撕裂并伴有静脉交通。边缘光滑的动脉狭窄（50例患者）与良性临床病程相关，但与动脉血流减慢合并时除外——这是骨筋膜室综合征的特征性表现（13例患者中的6例）。动脉狭窄呈不规则串珠样（23例患者）与严重损伤、随后骨折愈合不良及伤口感染相关。详细的血管造影图在规划手术管理方面具有重要价值。主要血管造影异常的缺失通常消除了手术探查的必要性；损伤部位及远端血流途径影响保守治疗的可行性；闭塞长度影响大隐静脉采集的必要性；动脉外渗部位决定手术结扎或经导管栓塞的可取性；骨筋膜室综合征的血管造影特征可能首先提示是否需要进行筋膜切开术。
