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Tue, 26 Feb 2002 18:08:59 EST

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In a message dated 2/26/2002 5:47:18 PM Eastern Standard Time, 
karim@trauma.org writes:

> If you're satisfied with the repair, and the distal limb is warm, well
> perfused and has pulses - is there any benefit to completion angiography?
> 
> If you have a warm, well-perfused, viable limb - would you act on any angio
> findings??

No--most who do vascular trauma--or vascular surgery in general--would agree 
that in the presence of clear evidence of perfusion a completion angio is not 
necessary.  A palpable pulse is clear evidence of an intact vessel--anything 
less, tho, can be quite treacherous, so be careful!  The biggest mistake I 
have seen made has been hearing Doppler signals in the absence of a palpable 
pulse--and audible Doppler signals do NOT confirm intact vessel, nor do they 
exclude an occluded vessel.  Doppler signals can result from collateral flow 
around an occlusion--well known.  Collaterals cannot give rise to a palpable 
pulse.  Or--"thinking" you feel a pulse, or any other level of 
uncertainty--should mandate confirmation with a completion angio.  It is not 
uncommon for vessel spasm to occur after vascular injury and repair, and for 
pulses to be very difficult to palpate at this time--a completion angio is 
the only way to confirm the nonpalpable pulse is not due to an occlusion.  In 
the same vein, clinical signs of perfusion, like warmth, color, etc, are much 
less reliable than a palpable pulse, so in the absence of the latter, beware 
of the former.  Remember--spasm is spelled C-L-O-T--only contrast can 
confirm.  Certain vessels--especially the popliteal artery--mandate more 
aggressive confirmation with completion angio, due to the higher risk of limb 
loss for any failure of revascularization compared with other vessels.  
Completion angio is very easy to do, and takes just a few minutes--small 
price to pay for certainty, as opposed to a treacherous "guess"
ERF

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<HTML><FONT FACE=arial,helvetica><FONT  COLOR="#0000ff" SIZE=2 FAMILY="SCRIPT" FACE="Comic Sans MS" LANG="0"><B>In a message dated 2/26/2002 5:47:18 PM Eastern Standard Time, karim@trauma.org writes:<BR>
<BR>
</FONT><FONT  COLOR="#000000" style="BACKGROUND-COLOR: #ffffff" SIZE=2 FAMILY="SANSSERIF" FACE="Arial" LANG="0"></B><BR>
<BLOCKQUOTE TYPE=CITE style="BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px">If you're satisfied with the repair, and the distal limb is warm, well<BR>
perfused and has pulses - is there any benefit to completion angiography?<BR>
<BR>
If you have a warm, well-perfused, viable limb - would you act on any angio<BR>
findings??</BLOCKQUOTE><BR>
</FONT><FONT  COLOR="#0000ff" style="BACKGROUND-COLOR: #ffffff" SIZE=2 FAMILY="SCRIPT" FACE="Comic Sans MS" LANG="0"><B><BR>
No--most who do vascular trauma--or vascular surgery in general--would agree that in the presence of clear evidence of perfusion a completion angio is not necessary.&nbsp; A palpable pulse is clear evidence of an intact vessel--anything less, tho, can be quite treacherous, so be careful!&nbsp; The biggest mistake I have seen made has been hearing Doppler signals in the absence of a palpable pulse--and audible Doppler signals do NOT confirm intact vessel, nor do they exclude an occluded vessel.&nbsp; Doppler signals can result from collateral flow around an occlusion--well known.&nbsp; Collaterals cannot give rise to a palpable pulse.&nbsp; Or--"thinking" you feel a pulse, or any other level of uncertainty--should mandate confirmation with a completion angio.&nbsp; It is not uncommon for vessel spasm to occur after vascular injury and repair, and for pulses to be very difficult to palpate at this time--a completion angio is the only way to confirm the nonpalpable pulse is not due to an occlusion.&nbsp; In the same vein, clinical signs of perfusion, like warmth, color, etc, are much less reliable than a palpable pulse, so in the absence of the latter, beware of the former.&nbsp; Remember--spasm is spelled C-L-O-T--only contrast can confirm.&nbsp; Certain vessels--especially the popliteal artery--mandate more aggressive confirmation with completion angio, due to the higher risk of limb loss for any failure of revascularization compared with other vessels.&nbsp; Completion angio is very easy to do, and takes just a few minutes--small price to pay for certainty, as opposed to a treacherous "guess"<BR>
ERF</B></FONT></HTML>

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Completion angiography?