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The Success of Duplex Ultrasonographic Scanning in Diagnosis of Extremity Vascular Proximity Trauma

William R. Fry, MD; R. Stephen Smith, MD; David V. Sayers, RVT; Vernon J. Henderson, MD; Diane J. Morabito, RN, MPH; Edmund K. Tsoi, MD; Jay K. Harness, MD; Claude H. Organ Jr, MD
Arch Surg. 1993;128(12):1368-1372. doi:10.1001/archsurg.1993.01420240076015.
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Objective:  To determine if duplex ultrasonographic scanning is diagnostically equivalent to arteriography and/or operative exploration in the diagnosis of extremity vascular proximity trauma.

Design:  A prospective evaluation comparing duplex scanning with arteriography or operative exploration in 50 patients. Subsequently, duplex scanning was used alone for 175 extremity vascular proximity injuries, with other diagnostic methods used when injury was indicated on the duplex scan.

Setting:  A busy urban trauma center.

Patients:  Consecutive sample of 200 patients with 225 extremity injuries.

Selection Criteria:  Vascular proximity injury or diminished strength of the extremity pulse.

Main Outcome Measures:   The presence or absence of vascular proximity injury confirmed on angiography and/or operative exploration.

Results:  Duplex scanning had 100% sensitivity and 100% specificity compared with arteriography and/or operative exploration in the first 50 cases. In the remaining 175 cases of extremity trauma, vascular injuries were diagnosed with duplex scanning alone. Duplex scanning detected 18 injuries, 17 of which were confirmed by correlation with arteriograms and/or operative exploration. One false-positive result—spasm of the superficial femoral artery—was found on arteriography. Seven unsuspected venous injuries were also diagnosed.

Conclusions:  Duplex scanning is a noninvasive, safe, effective method for the initial evaluation of potential extremity vascular proximity injury. It has replaced arteriography in the initial diagnosis of extremity vascular proximity trauma by our trauma service.(Arch Surg. 1993;128:1368-1372)


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