Evaluation and Management of Peripheral
Annotation for Point J
Multidetector row helical CTA has the advantages of using only intravenous contrast, being readily available in almost all American hospitals evaluating injured patients, and having an accuracy comparable with that of conventional arteriography.47–50 As it can be readily performed at the same time as other CT evaluations, it is cost effective as well.50 Since conventional arteriography of the extremities has increased risks in children, CTA would be of particular benefit in this group. Limitations in diagnostic quality may occur when metallic fragments or bullets cause CT artifacts, but this was not a significant problem in a recent series from a military hospital.51 Also, no therapeutic interventions can be performed during the study. Finally, the increased contrast load needed may be detrimental in a patient with preexisting renal insufficiency or a concurrent renal injury.