Gagne P J, Cone J B, McFarland D, Troillett R, Bitzer L G, Vitti M J, Eidt J F
Department of Surgery, University of Arkansas for Medical Sciences Medical Center, Little Rock, USA.
J Trauma. 1995 Dec;39(6):1157-63. doi: 10.1097/00005373-199512000-00026.
The diagnosis and management of occult vascular injuries caused by penetrating proximity extremity trauma (PPET) remains controversial. Over 18 months, we prospectively screened 37 patients (43 lower extremities) with PPET for occult arterial and venous injuries using noninvasive studies (physical examination, ankle-brachial indices, color-flow duplex ultrasonography (CFD)) and angiography (arteriography, venography). Eight isolated, occult venous injuries were detected (incidence, 22%). CFD detected seven of eight (88%) venous injuries. Venography was technically difficult to perform in this patient population and failed to detect four femoral-popliteal vein injuries. Major thromboembolic complications (pulmonary embolism, symptomatic deep vein thrombosis, venous claudication) occurred in 50% of the patients identified with femoral-popliteal vein injuries. Arterial injuries were detected in 4 of 42 (10%) extremities (arteriography, n = 3; CFD, n = 1) and were clinically benign. We conclude that following PPET, (1) isolated, occult venous injuries are common and are associated with significant complications and (2) CFD is useful for screening for occult venous injuries.
穿透性近侧肢体创伤（PPET）所致隐匿性血管损伤的诊断和处理仍存在争议。在18个月的时间里，我们采用非侵入性检查（体格检查、踝臂指数、彩色血流双功超声检查（CFD））和血管造影（动脉造影、静脉造影），对37例（43条下肢）PPET患者进行了隐匿性动脉和静脉损伤的前瞻性筛查。共检测到8例孤立性隐匿性静脉损伤（发生率为22%）。CFD检测出8例静脉损伤中的7例（88%）。在该患者群体中，静脉造影在技术上难以实施，有4例股腘静脉损伤未被检测到。在确诊为股腘静脉损伤的患者中，50%发生了严重的血栓栓塞并发症（肺栓塞、有症状的深静脉血栓形成、静脉性跛行）。42条肢体中有4条（10%）检测到动脉损伤（动脉造影3例，CFD 1例），且均为临床良性。我们得出结论，PPET后，（1）孤立性隐匿性静脉损伤很常见，且伴有严重并发症；（2）CFD有助于筛查隐匿性静脉损伤。
