Lower Extremity Arterial Trauma

A middle aged male presented with a femur fracture sustained after a tree fell on his leg. After closed reduction of the fracture, peripheral pulses were absent. Diagnostic conventional angiogram demonstrated a dissection of the distal superficial femoral artery at the level of the fracture with no distal reconstitution of the popliteal artery.

Imaging recommendations:

• perform CT angiography in patients who are stable and have suspected (but not confirmed) arterial injury
• faster than conventional angiography
• limitations include poor timing of contrast bolus, streak and motion artifact
• conventional angiography in patients with strong indication of arterial injury
• prolongs ischemic time 
• radiologic intervention is possible and preferred over surgical exploration.

REFERENCES
Miller-Thomas MM, West OC, Cohen AM. Diagnosing traumatic arterial injury in the extremities with CT angiography: pearls and pitfalls. Radiographics 2005;25:S133-42.
Rieger M, Mallouhi A, Tauscher T, et al. Traumatic arterial injuries of the extremities: initial evaluation with MDCT angiography. AJR Am J Roentgenol 2006;186(3):656-64.