Contrast Arteriography
Although imaping of arteries through the intraluminal injection of radiopaque contrast is now a common tool for the evaluation of extremity trauma for vascular injury, it took several decades foi this role to develop. As repair ot vascular injuries became established in the fnilitary and civilian sec- tors in the 1950s, and the danpers of missed or delayed diagnoses became evident, immediate surgical exploration was the standard diagnostic modality applied to all limbs at risk
for vascular injury through the 1970s. 0 2 ”""'* This u'as
questioned by many in view of its costs, complication rate of 3%, and a rate of negative explorations as high as 809o' .
Arteriography was arbitrarily applied to the diagnosis of extremity vascular trauma during the 1960s and 1970s."" "" It was very accurate at confirming most vascular injuries in symptomatic limbs, but this was superfluous, unnecessarily costly, and time-consuming in view of how reliably hard signs on physical examination already does this." Also, sev- eral clinical and experimental studies had indicated its accu-
racy at excluding vascular trauma in asymptomatic injured limbs was poor. 0 52 83 By the mid- to late 1980s, as arteriogra-
phy became more technically sophisticated, several studies, incliiding one long-term follow-up,’' established this modal- ity to be as accurate as surgical exploration at excluding ex-
tremity vascular injury, even in the most problematic setting of asymptoirratic penetrating proximity trauma. 6 7 '“’Such
“exclusion” arteriography led to large cost reductions in the evaluation of injured limbs for vascular injury, reducing neg- ative limb explorations to as low as 209o, and with low false- negative rates and sensitivities of 95 to 99%, entirely comparable to surgery (Table 43—5). lt is a safer modality
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