Evaluation and Management of Peripheral
Annotation for Point I
Standard arteriography options include conventional film, digital subtraction after intra-arterial or intravenous injection of a contrast agent, or surgeon-performed “one-or two-shot” studies.26,42–44 Digital subtraction arteriography has replaced conventional film arteriography in most centers, because it decreases the time of examination, amount of contrast material, discomfort of the patient, and costs of films.42,43 A mobile digital subtraction arteriography unit can even be used in the trauma resuscitation room when surgeon-angiographers are available.45 If computed tomographic angiography (CTA) (see below) is not available, surgeon-performed arteriography can be performed in the emergency center using conventional films and one or two intra-arterial injections of 25 mL to 50 mL of meglumine diatrizoate dye. In the operating room, surgeon-performed arteriography can be performed under fluoroscopy or with the use of conventional films. Surgeon-performed percutaneous intra-arterial injection studies in injured patients have a complication rate of 1% to 4% and sensitivity/specificity greater than 95%.44,46 As certain contrast agents cause renal toxicity, adequate fluid resuscitation is mandatory before all the studies described.