Sixty-four slice multidetector computed tomographic angiography in the evaluation of vascular trauma

Background: Artifacts produced by metallic fragments and orthopedic hardware limit the usefulness of conventional computed tomography in many military trauma patients. Contemporary literature suggests that multidetector computed tomographic angiography (MDCTA) by resolving these limitations may provide a useful noninvasive alternative to invasive arteriography. The objective of this study is to review the utility of MDCTA in the evaluation of recent combat casualties with vascular injuries. Methods: Data on all vascular trauma patients seen by our service has been collected prospectively and entered into a database. A retrospective review was conducted of patients seen from August through December 2006 who underwent MDCTA. Patient demographics, mechanism of injury, modality of evaluation, and findings were recorded. Results: Twenty patients underwent MDCTA. Thirteen patients were injured by blast fragments. Seven patients were injured by gunshot wounds. Nineteen of 20 studies were diagnostic and one was judged to be indeterminate. Studies in nine patients identified arterial injuries. Multiple extremities were evaluated with a single study in 16 patients. Fifteen studies assessed the lower extremities, four the upper extremities and two the neck. Fourteen patients in this series had retained fragments, 10 had external fixators or intramedullary rods, and only 4 had neither retained fragments nor orthopedic hardware. MDCTA allowed for assessment of the arterial runoff despite hardware or fragments in 15 of 16 (94%) patients. Comparative studies were available in four patients in addition to MDCTA. There were no missed injuries in these four patients. Conclusions: MDCTA yielded high resolution images that were very useful for the delayed evaluation of combat casualties. The presence of metallic fragments or orthopedic hardware did not significantly interfere with MDCTA. It is a reliable and promising alternative to traditional arteriography for evaluating clinically occult vascular trauma.