• Timothy I Joseph, Prasanna J Ratnakanthan, Eldho Paul, and Warren Clements.
• Department of Radiology and Nuclear Medicine, Alfred Health, 55 Commercial Rd., Melbourne, Vic, Australia (T.I.J., P.R., W.C.); Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road (E.P) and Department of Surgery, Monash University, Melbourne, Vic., Australia (W.C.); National Trauma Research Institute Monash University, Australia (W.C.). Electronic address: ti.joseph@alfred.org.au.
• Injury. 2021 Oct 1; 52 (10): 3064-3067.

IntroductionCT angiography (CTA) is efficient and accurate in detecting lower limb vascular injury in the setting of trauma (1-6). Less clear is the in-practice correlation between appropriate indications for these examinations and subsequent clinical impacts.Materials And MethodsAll CT leg angiography acquired from January 2016 through April 2019 were reviewed via retrospective search. Studies not acquired for trauma were excluded. Imaging and reports were reviewed to assess for vascular injury. Electronic medical records were reviewed to assess the presence or absence of classical 'hard' or 'soft' signs of vascular injury and whether vascular intervention was undertaken.ResultsA total of 347 lower limb injuries were identified in 273 men and 74 women. Mean age was 41.5 years ranging from 15-95 years. 268 cases were fractures with 177 open injuries. 301 of injuries were secondary to blunt trauma, 31 penetrating injury occurred and 15 cases were ascribed to blast/gunshot injury. 74 (21.3%) studies were deemed to have a positive finding of vascular injury, 249 (71.8%) were reported as negative and 24 (6.9%) were indeterminate. Of the cases with positive findings, 26 underwent intervention (7.4% of all patients undergoing CTA). No patients with negative CTA required intervention, while three (3, 0.8% of total) with indeterminate findings required intervention. Where there were no clinical signs (absence of any hard or soft signs) 249 CTA's were performed and none required any form of intervention.ConclusionIn the absence of clinical signs of vessel injury, CT angiography is unlikely to demonstrate vascular injury requiring intervention in the setting of lower limb trauma.Copyright © 2021. Published by Elsevier Ltd.

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