Posts Tagged → Penetrating Trauma

Arterial Pressure Indices

Indications

  • Assess for peripheral arterial disease (PAD)
  • Assess for risk of arterial injury in trauma

Test characteristics

  • PAD: ABI <0.90 sensitivity 95%, specificity 100% for >50% stenosis on arteriography1
  • Trauma: API <0.90 sensitivity 95%, specificity 97% for major arterial injury2

Technique for obtaining arterial pressure indices3

  1. Patient lies supine with extremities at level of the heart for 10 minutes
  2. Ankle: cuff positioned just above malleolus
  3. Brachial: cuff positioned just above antecubital fossa
  4. Doppler SBP
  5. Sequence: first arm, first PT, first DP, other PT, other DP, other arm. If SBP of first arm >10mmHg compared to second arm, repeat first arm and disregard first measure
  6. Calculation: ABI = higher of DP or PT / higher arm

Interpretation of ABI for PAD3

Value Interpretation
0-0.40 Severe PAD, rest pain, gangrene
0.41-0.90 PAD, claudication
0.91-1.30 Normal
>1.30 Non-compressible, severely calcified

Algorithm for the Evaluation of Arterial Injury4, 5

Algorithm for the Evaluation of Arterial Injury

Notes:

  • † If unable to palpate pulses due to patient habitus or shock/hypothermia, reattempt with oversized cuff and after appropriate rewarming/resuscitation. If remains challenging, proceed with imaging.
  • ‡ Proximal LE arterial injuries refers to the major named arteries of the thigh (excluding the profunda femoris) and proximal to the anterior tibial artery and tibioperoneal bifurcation.

Arteries of the Lower Leg

References:

  1. Mohler ER. Peripheral arterial disease: identification and implications. Arch Intern Med. 2003;163(19):2306-2314. doi:10.1001/archinte.163.19.2306.
  2. Johansen K, Lynch K, Paun M, Copass M. Non-invasive vascular tests reliably exclude occult arterial trauma in injured extremities. The Journal of Trauma: Injury, Infection, and Critical Care. 1991;31(4):515–9–discussion519–22.
  3. Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation. 2012;126(24):2890-2909. doi:10.1161/CIR.0b013e318276fbcb.
  4. Feliciano DV, Moore FA, Moore EE, et al. Evaluation and management of peripheral vascular injury. Part 1. Western Trauma Association/critical decisions in trauma. J Trauma. 2011;70(6):1551-1556. doi:10.1097/TA.0b013e31821b5bdd.
  5. Fox N, Rajani RR, Bokhari F, et al. Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S315-S320. doi:10.1097/TA.0b013e31827018e4.
  6. Inaba K, Branco BC, Reddy S, et al. Prospective evaluation of multidetector computed tomography for extremity vascular trauma. J Trauma. 2011;70(4):808-815. doi:10.1097/TA.0b013e3182118384.