False-negative Angiograms in Missed Vascular Injuries

Arch Surg. 1988;123(2):258-259. doi:10.1001/archsurg.1988.01400260146023.
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To the Editor.—Richardson et al1 are to be commended on their article, which appeared in the June issue of the Archives, especially with regard to their long-term follow-up of this indigent population. Technical improvement hinges on evaluation of our errors and recognition of blind spots. For this reason, we wish to learn more about the angiographic false-negative examinations in their series.

Eight patients described as angiographically normal were subsequently discovered to have sustained major arterial injury. What means were used to identify and prove vascular injury in these patients? Also, what was the time interval between the normal angiographic study and the subsequent discovery of arterial injury? Two patients were reported to have arterial thrombosis following a normal angiogram. Were the arteries intrinsically abnormal (eg, missed intimal flap), or could the occlusion have occurred on the basis of a delayed compartment syndrome? Interestingly, the one "normal" angiographic illustration


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