Vascular injuries represent less than 3% of all traumatic findings, yet they are associated with potentially severe complications . If not recognized and treated fast, injuries to major arteries may have devastating consequences resulting in amputations or even death.
Knowing the mechanism of the trauma is of extreme importance for making the correct diagnosis. Although blunt trauma is a common cause of acute trauma presentation in the civil population worldwide, the increasing urban violence in our region has produced a rise of penetrating trauma produced by gun shot and stab wounds that deserve especial considerations . Most vascular injuries are caused by penetrating trauma, such as motor vehicle accidents, gunshot wounds, stabbing, and blast injuries . Blunt trauma causes significant soft tissue injury, while vascular disorders are less frequent . Nonetheless, also in blunt trauma, vascular injuries need to be ruled out, especially in patients with displaced long bone fractures, crush injuries, and patients with prolonged immobilization . Blunt trauma is more often associated with partial or complete vascular occlusion, arterial dissections, and intimal flaps, while penetrating trauma can also cause pseudoaneurysms, arteriovenous fistulas, and vein thrombosis .
In our study we considerd the CT angiography is golden standard for diagnosis of post traumatic arterial injuries of the extremities and we compare the Doppler findings to it.
Comparing the results of color Doppler ultrasonography with CT angiographic studies done on the 50 patients we found that there is concordance between their results in 45 cases and 5 cases of discrepancy so color Doppler sensitivity is 97 % and positive predictive value is 90%. there is 45 cases of true positive results of 90 % of all study cases, and 4 cases with false positive results of 8 % of all study cases and 1 case show false negative result of 2 % of all study cases .
In our study we depend mainly on Distal flow analysis when performing doppler study , We depend mainly on this method as the exact site of arterial injury commonly show tissue loss , open fracture and hidden by casting as well as this method saving time.
Also Doppler US has 100 % sensitivity in detection of arterial thrombosis either acute or chronic thrombosis which is superior to CT angiography which can detect only acute thrombosis due to arterial distention, but in chronic thrombosis the artery is of normal diameter and CTA show only non opacified lumen but ultrasonography and Doppler can detect the thrombosis.
We can limit the role of CT angiography in only patients with damped post traumatic arterial flow in which the suspected site of arterial injury is non accessible by overlying large cut wound, open fracture and early casting for immobilization .
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