CT Angiography in Trauma
Section snippets
Technique
The diagnostic quality of a CTA examination depends on many factors, but careful attention to technique and adequate patient preparation are always necessary, especially in the setting of trauma when multiple events often happen simultaneously and every second may be critical.
The importance of proper patient positioning cannot be underestimated. Patients are typically placed supine on a CT table. In the majority of cases (chest, abdomen, pelvis, or lower-extremity imaging), placing both arms
CTA of the chest
Thoracic injuries account for 25% of trauma-related deaths in the United States and the thorax is the third most commonly injured body part in trauma.1 MDCT angiography has rapidly become the imaging modality of choice in evaluating a wide variety of potentially life-threatening acute traumatic injuries of the aorta and other large vessels.2, 3, 4, 5 CTA provides high-resolution axial, multiplanar, and 3-D data sets, which enable rapid diagnosis and characterization of thoracic vascular
CTA of the abdomen
The main purpose of the abdominal CT examination in trauma patients is to detect injuries to and bleeding arising from the solid organs, hollow viscera, and mesentery, but the major abdominal vessels can also be evaluated.20, 21, 22, 23 Currently, specific CTA (arterial phase) images are not routinely obtained as part of the abdominal CT protocol at most large trauma centers. The upper abdominal aorta and its branches, however, are often scanned in a late arterial phase because the lower images
CTA of the pelvis
Patients who suffer major blunt pelvic trauma and sustain displaced fractures have a high risk of major pelvic vascular injuries, with significant mortality and morbidity.38, 39, 40, 41, 42 Approximately 40% of patients with a pelvic fracture may have an associated pelvic vascular injury and hemorrhage is the leading cause of mortality in 60% of cases.26, 39, 40, 41, 43 Rapid detection and assessment of pelvic vascular injury afforded by the shorter acquisition times and increased spatial
CTA of the extremities
Historically, DSA was the primary imaging modality for assessing the vascular integrity of the extremity in trauma patients.47, 48, 49 CTA, however, has increasingly become an invaluable tool in the detection and characterization of extremity vascular injuries.47, 48, 50, 51, 52, 53, 54, 55, 56 More recently, faster CT acquisition times and the development of longer CT tables that allow the acquisition of whole-body CT digital radiographs have led to the development of more complex and robust
CTA of the head and neck
Blunt and penetrating traumatic arterial injuries of the neck have traditionally been assessed by catheter angiography. The high number of negative examinations and the risks associated with catheter angiogram, however, have prompted the use of noninvasive techniques. MDCT angiography is sensitive and specific for the evaluation of carotid and vertebral artery injuries.58, 59, 60, 61 Cerebrovascular injuries occur in 1.2% to 2.7% of blunt trauma patients but up to 25% of patients who have
Summary
Currently, with widely available MDCT technology, the first-line assessment of vascular injury in trauma patients is CTA. CTA affords a rapid, accurate, noninvasive method of detecting vascular injury and appropriately triaging patients to receive the requisite intervention, when necessary. With careful attention to technique and an understanding of commonly encountered vascular injuries in trauma, high-quality, diagnostic CTAs offer an invaluable tool in the imaging evaluation of injured
References (70)
- et al.
Diagnosis of blunt traumatic aortic injury 2007: still a nemesis
Eur J Radiol
(2007) - et al.
Blunt traumatic aortic injury: initial experience with endovascular repair
J Vasc Surg
(2009) - et al.
CT of pelvic fractures
Eur J Radiol
(2004) - et al.
CT angiography of extremity trauma
Tech Vasc Interv Radiol
(2006) - et al.
The role of 3D-CTA in the assessment of peripheral vascular lesions in trauma patients
Eur J Radiol
(2007) - et al.
Multidetector CT of blunt thoracic trauma
Radiographics
(2008) - et al.
Acute traumatic aortic injury: imaging evaluation and management
Radiology
(2008) - et al.
Thoracic aortic injury: how predictive is mechanism and is chest computed tomography a reliable screening tool? A prospective study of 1,561 patients
J Trauma
(2000) - et al.
The evolution of chest computed tomography for the definitive diagnosis of blunt aortic injury: a single-center experience
J Trauma
(2004) - et al.
Periaortic hematoma at diaphragmatic crura at helical CT: sign of blunt aortic injury in patients with mediastinal hematoma
Radiology
(2004)
Blunt and penetrating trauma of the thoracic aorta and aortic arch branches: an Autopsy Study
J Trauma
Prospective study of blunt aortic injury: multicenter trial of the american association for the surgery of trauma
J Trauma
Thoracic aorta injuries: management and outcome of 144 patients
J Trauma
Vascular emergencies of the thorax after blunt and iatrogenic trauma: multi–detector row CT and three-dimensional imaging
Radiographics
Stanford type a aortic dissection after blunt chest trauma: case report with a reflection on the mechanism of injury
J Trauma
Endovascular stent-graft treatment of thoracic aortic disease
Radiographics
Stent-graft placement for the treatment of thoracic aortic diseases
Radiographics
Pseudoaneurysms and the role of minimally invasive techniques in their management
Radiographics
Short and midterm results with minimally invasive endovascular repair of acute and chronic thoracic aortic pathology
J Vasc Surg
Immediate versus delayed endovascular treatment of post-traumatic aortic pseudoaneurysms and type B dissections: retrospective analysis and premises to the upcoming european trial
Circulation
Radiographic and CT findings of blunt chest trauma: aortic injuries and looking beyond them
Radiographics
Avulsion of the innominate artery associated with fracture of the sternum
AJR Am J Roentgenol
Blunt abdominal trauma: performance of CT without oral contrast material
Radiology
CT in abdominal and pelvic trauma
Radiographics
CT angiography of the lower extremities and aortoiliac system with a multi–detector row helical CT scanner: promise of new opportunities fulfilled
Radiology
Special focus session: multidetector CT: abdominal visceral imaging
Radiographics
Multidetector computed tomography findings of atypical blunt traumatic aortic injuries: a pictorial review
Emerg Radiol
Continuing medical education: traumatic retroperitoneal injuries: review of multidetector CT findings
Radiographics
Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients
Radiographics
Nontraumatic emergent abdominal vascular conditions: advantages of multi–detector row CT and three-dimensional imaging
Radiographics
Blunt force injury of the abdominal aorta
J Trauma
CT in blunt liver trauma
Radiographics
Using contrast-enhanced helical CT to visualize arterial extravasation after blunt abdominal trauma
AJR Am J Roentgenol
Active extravasation of the abdomen and pelvis in trauma using 64MDCT
Emerg Radiol
Blunt splenic trauma: delayed-phase CT for differentiation of active hemorrhage from contained vascular injury in patients
Radiology
Cited by (25)
Vascular Injuries in Head and Neck Trauma
2023, Radiologic Clinics of North AmericaPreintervention Computed Tomography Improves the Performance of Endovascular Intervention in Patients with Abdominopelvic Trauma
2022, Journal of Vascular and Interventional RadiologyConsiderations for Conduit Repair of Vascular Injury
2021, Rich’s Vascular TraumaAcute Abdomen in Adult Trauma
2020, Seminars in RoentgenologyCitation Excerpt :Hemorrhage in these patients can be multifactorial, emanating from torn pelvic arteries or veins, bleeding from the bone itself, or from other injured intra-abdominal organs. About 40% of patients with a pelvic fracture will have a pelvic vascular injury, which is a significant cause of mortality.52 Pelvic fractures can be described using the Young-Burgess classification scheme, depending on mechanism of impact as lateral compression (LC), anterior-posterior compression (APC), or vertical shear.
A possible novel technique for intraoperative imaging of the vertebral artery during arthrodesis of the upper cervical spine
2020, Medical HypothesesCitation Excerpt :An atherosclerotic stenosis of the vertebral artery is a common entity, reported up to 25% in the elderly patients [9]. The precise percentage of vertebral artery injury after a cervical trauma remains unknown, reported up to 1, 2% in C1-C2 fractures because some of these injuries remain clinically silent because of the retrograde flow of the other vertebral artery, thus preventing neurological symptoms [11]. The possible occlusion of healthy vertebral artery during stabilization surgery is going to lead to devastating consequences for the patients.
Damage Control: Considerations for Vascular Conduit in the Repair of Vascular Injury
2015, Rich's Vascular Trauma