Proximity injuries: correlation with results of extremity arteriography.

The results of 170 emergency arteriography procedures in 142 patients who had sustained extremity injuries near major arteries were correlated with the findings from a physical examination conducted prior to arteriography. Radiographically demonstrable significant arterial injuries, which usually required surgical repair, were present at 42 of the 170 injury sites (25%). Major physical findings suggestive of arterial injury were noted at 105 of 170 sites (62%). Arteriography demonstrated a significant injury in 40 (38%) of these 105 injury sites, representing 95% of all major arterial injuries. Among the 65 injury sites without any suggestive major physical finding, only two were associated with a significant vascular injury at arteriography (3%) (5% of all 42 arterial injuries). At each of these 65 injury sites, the decision to perform emergency arteriography was based solely on the proximity of the wound to a major artery. In spite of this very low yield in the subgroup of 51 patients without major physical findings, emergency arteriography is still routinely requested for extremity injuries at the authors' institutions. The validity of this policy, a possible reason for its development, and its effect on patient disposition are examined.