The diagnosis and management of occult
vascular injuries caused by penetrating proximity extremity
trauma (
PPET) remains controversial. Over 18 months, we prospectively screened 37 patients (43 lower extremities) with
PPET for occult arterial and venous
injuries using noninvasive studies (physical examination, ankle-brachial indices, color-flow duplex ultrasonography (CFD)) and angiography (arteriography, venography). Eight isolated, occult venous
injuries were detected (incidence, 22%). CFD detected seven of eight (88%) venous
injuries. Venography was technically difficult to perform in this patient population and failed to detect four femoral-popliteal vein
injuries. Major thromboembolic complications (
pulmonary embolism, symptomatic
deep vein thrombosis, venous claudication) occurred in 50% of the patients identified with femoral-popliteal vein
injuries. Arterial
injuries were detected in 4 of 42 (10%) extremities (arteriography, n = 3; CFD, n = 1) and were clinically benign. We conclude that following
PPET, (1) isolated, occult venous
injuries are common and are associated with significant complications and (2) CFD is useful for screening for occult venous
injuries.