Emergency room retrograde transbrachial arteriography for the management of axillosubclavian vascular injuries

Emergency room retrograde transbrachial arteriography for the management of axillosubclavian vascular injuries

Author Aerts, N. R. Google Scholar
Figueiredo, LFP de Google Scholar
Burihan, E. Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Pronto Socorro Hosp
Abstract Background: our purpose was to determine the accuracy of single-injection, retrograde transbrachial arteriography (RTBA), performed in the emergency room, for suspected axillosubclavian injuries.Methods: Thirty-three patients were prospectively assigned for RTBA. Clinical indications for RTBA included high-risk mechanism of injury, decreased (n = 19) or absent (n = 5) brachial pulse, neurologic deficits (n = 11), external or intrathoracic bleeding (n = 4), and bruit (n = 2). Brachial artery was cannulated with an 18-gauge catheter. A sphygmomanometer cuff was placed at the forearm and inflated to 250 mm Hg. Twenty milliliters of nonionic contrast media was injected countercurrent and a single anteroposterior chest radiograph was obtained. Small intimal flaps were followed by serial ultrasound. Surgical findings were used to establish RTBA accuracy.Results. RTBA was successfully performed in all cases. Arterial lesions were detected in 28 (84.8%) patients, including thrombosis (n = 8), arteriovenous fistula (n = 8), and false aneurysm (n = 7) as the most frequent lesions. A sensitivity of 96.5%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 80% were observed with RTBA.Conclusion. We conclude that RTBA is a safe and accurate technique to be used in the emergency room for the rapid detection of axillosubclavian arterial injuries.
Keywords accuracy
arteriography
axillosubclavian trauma
bleeding
vascular trauma
Language English
Date 2003-07-01
Published in Journal of Trauma-injury Infection and Critical Care. Philadelphia: Lippincott Williams & Wilkins, v. 55, n. 1, p. 69-73, 2003.
ISSN 0022-5282 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 69-73
Origin http://dx.doi.org/10.1097/01.TA.0000073135.07925.B7
Access rights Closed access
Type Article
Web of Science ID WOS:000187276500012
URI http://repositorio.unifesp.br/handle/11600/27317

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