Impact of routine arteriography on management of penetrating neck injuries

We evaluated the impact of routine arteriography on the management of 105 patients with penetrating injuries to the neck and upper chest. Of 72 patients with bullet wounds and 33 with knife wounds, surgical exploration on an emergency basis was performed in three patients because of shock; the remaining 102 underwent aortic arch or selective arteriography. Surgical exploration was performed in 18 patients because of abnormal arteriograms and in 13 (10 with normal arteriograms) because of shock or suspected hemorrhage. Operative findings confirmed the angiographic interpretation in 26 of the 31 patients who were explored. The angiogram underestimated the arterial injury in two patients and failed to identify an associated venous injury in three. Seventy-two patients with negative arteriograms received expectant treatment without subsequent complications. Routine arteriography is integral to expeditious triage and accurate diagnosis of patients with brachiocephalic trauma. A negative study in almost 80% of patients permits safe nonoperative management, whereas a positive study allows the surgeon to plan his operative approach more judiciously. Endoscopic procedures are important adjuncts in selected patients.