Natural history, duplex characteristics, and histopathologic correlation of arterial injuries in a canine model

Thomas F. Panetta, Clifford M. Sales, Michael L. Marin, Michael L. Schwartz, Anne M. Jones, George L. Berdejo, Kurt R. Wengerter, Frank J. Veith

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

The treatment of patients with penetrating extremity trauma in proximity to major arteries as well as the nonoperative treatment of clinically occult arterial injuries remain controversial. Duplex ultrasonography (DUS) has recently been advocated in this setting. We therefore studied experimentally induced arterial injuries in dogs to correlate the natural history, duplex findings, and histopathologic condition of different injuries and to help define criteria for operation. Fifty-two canine femoral and carotid arteries were randomized to have surgically created intimal flaps (n = 15), crush injuries (n = 15), or lacerations (n = 15) or to be controls (n = 7). An experienced sonographer, blinded to the presence or type of injury, evaluated the vessels every 10 days for 1 month. Histopathologic study was performed 1 month after injury when the arteries were retrieved. The sensitivity (96.5%), specificity (86.4%), and accuracy (95.1%) of DUS in evaluating arterial injuries at 1 month correlated well with histopathologic evaluation. All arteries subjected to crush injuries showed abnormal duplex findings. These findings correlated well with the histologic picture of severe injury (arterial wall thickness = 2.72 × ± 0.23 × control; intramural hemorrhage, 93%; mural thrombus, 60%). DUS and histologic study revealed healing of intimal flaps in 27% of the arteries. Other intimal flaps deteriorated (stenoses, 47%; dilation, 13%; occlusion, 13%). Most lacerations (86%) revealed duplex evidence of healing within 10 days of injury. This was confirmed by histologic study at 1 month in 73% of lacerated arteries. This study confirms the accuracy of DUS in diagnosing various arterial injuries and shows that the natural history of these injuries varies with the mechanism of injury. Arterial injuries with benign characteristics on DUS may not require repair; however, those with intramural hemorrhage, obstructing intimal defects, or progressive stenosis associated with increasing wall thickness may require repair. These data suggest a role for the nonoperative treatment of clinically occult arterial injuries based on duplex characteristics, and they indicate a need for clinical trials.

Original languageEnglish (US)
Pages (from-to)867-876
Number of pages10
JournalJournal of Vascular Surgery
Volume16
Issue number6
DOIs
StatePublished - Dec 1992
Externally publishedYes

Fingerprint

Natural History
Canidae
Wounds and Injuries
Tunica Intima
Ultrasonography
Arteries
Lacerations
Pathologic Constriction
Hemorrhage
Femoral Artery
Carotid Arteries
Dilatation
Thrombosis
Extremities
Clinical Trials
Dogs

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Panetta, Thomas F. ; Sales, Clifford M. ; Marin, Michael L. ; Schwartz, Michael L. ; Jones, Anne M. ; Berdejo, George L. ; Wengerter, Kurt R. ; Veith, Frank J. / Natural history, duplex characteristics, and histopathologic correlation of arterial injuries in a canine model. In: Journal of Vascular Surgery. 1992 ; Vol. 16, No. 6. pp. 867-876.
@article{0d72ea3eb61543b6985948d6ce394e0d,
title = "Natural history, duplex characteristics, and histopathologic correlation of arterial injuries in a canine model",
abstract = "The treatment of patients with penetrating extremity trauma in proximity to major arteries as well as the nonoperative treatment of clinically occult arterial injuries remain controversial. Duplex ultrasonography (DUS) has recently been advocated in this setting. We therefore studied experimentally induced arterial injuries in dogs to correlate the natural history, duplex findings, and histopathologic condition of different injuries and to help define criteria for operation. Fifty-two canine femoral and carotid arteries were randomized to have surgically created intimal flaps (n = 15), crush injuries (n = 15), or lacerations (n = 15) or to be controls (n = 7). An experienced sonographer, blinded to the presence or type of injury, evaluated the vessels every 10 days for 1 month. Histopathologic study was performed 1 month after injury when the arteries were retrieved. The sensitivity (96.5{\%}), specificity (86.4{\%}), and accuracy (95.1{\%}) of DUS in evaluating arterial injuries at 1 month correlated well with histopathologic evaluation. All arteries subjected to crush injuries showed abnormal duplex findings. These findings correlated well with the histologic picture of severe injury (arterial wall thickness = 2.72 × ± 0.23 × control; intramural hemorrhage, 93{\%}; mural thrombus, 60{\%}). DUS and histologic study revealed healing of intimal flaps in 27{\%} of the arteries. Other intimal flaps deteriorated (stenoses, 47{\%}; dilation, 13{\%}; occlusion, 13{\%}). Most lacerations (86{\%}) revealed duplex evidence of healing within 10 days of injury. This was confirmed by histologic study at 1 month in 73{\%} of lacerated arteries. This study confirms the accuracy of DUS in diagnosing various arterial injuries and shows that the natural history of these injuries varies with the mechanism of injury. Arterial injuries with benign characteristics on DUS may not require repair; however, those with intramural hemorrhage, obstructing intimal defects, or progressive stenosis associated with increasing wall thickness may require repair. These data suggest a role for the nonoperative treatment of clinically occult arterial injuries based on duplex characteristics, and they indicate a need for clinical trials.",
author = "Panetta, {Thomas F.} and Sales, {Clifford M.} and Marin, {Michael L.} and Schwartz, {Michael L.} and Jones, {Anne M.} and Berdejo, {George L.} and Wengerter, {Kurt R.} and Veith, {Frank J.}",
year = "1992",
month = "12",
doi = "10.1016/0741-5214(92)90049-E",
language = "English (US)",
volume = "16",
pages = "867--876",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "6",

}

Panetta, TF, Sales, CM, Marin, ML, Schwartz, ML, Jones, AM, Berdejo, GL, Wengerter, KR & Veith, FJ 1992, 'Natural history, duplex characteristics, and histopathologic correlation of arterial injuries in a canine model', Journal of Vascular Surgery, vol. 16, no. 6, pp. 867-876. https://doi.org/10.1016/0741-5214(92)90049-E

Natural history, duplex characteristics, and histopathologic correlation of arterial injuries in a canine model. / Panetta, Thomas F.; Sales, Clifford M.; Marin, Michael L.; Schwartz, Michael L.; Jones, Anne M.; Berdejo, George L.; Wengerter, Kurt R.; Veith, Frank J.

In: Journal of Vascular Surgery, Vol. 16, No. 6, 12.1992, p. 867-876.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Natural history, duplex characteristics, and histopathologic correlation of arterial injuries in a canine model

AU - Panetta, Thomas F.

AU - Sales, Clifford M.

AU - Marin, Michael L.

AU - Schwartz, Michael L.

AU - Jones, Anne M.

AU - Berdejo, George L.

AU - Wengerter, Kurt R.

AU - Veith, Frank J.

PY - 1992/12

Y1 - 1992/12

N2 - The treatment of patients with penetrating extremity trauma in proximity to major arteries as well as the nonoperative treatment of clinically occult arterial injuries remain controversial. Duplex ultrasonography (DUS) has recently been advocated in this setting. We therefore studied experimentally induced arterial injuries in dogs to correlate the natural history, duplex findings, and histopathologic condition of different injuries and to help define criteria for operation. Fifty-two canine femoral and carotid arteries were randomized to have surgically created intimal flaps (n = 15), crush injuries (n = 15), or lacerations (n = 15) or to be controls (n = 7). An experienced sonographer, blinded to the presence or type of injury, evaluated the vessels every 10 days for 1 month. Histopathologic study was performed 1 month after injury when the arteries were retrieved. The sensitivity (96.5%), specificity (86.4%), and accuracy (95.1%) of DUS in evaluating arterial injuries at 1 month correlated well with histopathologic evaluation. All arteries subjected to crush injuries showed abnormal duplex findings. These findings correlated well with the histologic picture of severe injury (arterial wall thickness = 2.72 × ± 0.23 × control; intramural hemorrhage, 93%; mural thrombus, 60%). DUS and histologic study revealed healing of intimal flaps in 27% of the arteries. Other intimal flaps deteriorated (stenoses, 47%; dilation, 13%; occlusion, 13%). Most lacerations (86%) revealed duplex evidence of healing within 10 days of injury. This was confirmed by histologic study at 1 month in 73% of lacerated arteries. This study confirms the accuracy of DUS in diagnosing various arterial injuries and shows that the natural history of these injuries varies with the mechanism of injury. Arterial injuries with benign characteristics on DUS may not require repair; however, those with intramural hemorrhage, obstructing intimal defects, or progressive stenosis associated with increasing wall thickness may require repair. These data suggest a role for the nonoperative treatment of clinically occult arterial injuries based on duplex characteristics, and they indicate a need for clinical trials.

AB - The treatment of patients with penetrating extremity trauma in proximity to major arteries as well as the nonoperative treatment of clinically occult arterial injuries remain controversial. Duplex ultrasonography (DUS) has recently been advocated in this setting. We therefore studied experimentally induced arterial injuries in dogs to correlate the natural history, duplex findings, and histopathologic condition of different injuries and to help define criteria for operation. Fifty-two canine femoral and carotid arteries were randomized to have surgically created intimal flaps (n = 15), crush injuries (n = 15), or lacerations (n = 15) or to be controls (n = 7). An experienced sonographer, blinded to the presence or type of injury, evaluated the vessels every 10 days for 1 month. Histopathologic study was performed 1 month after injury when the arteries were retrieved. The sensitivity (96.5%), specificity (86.4%), and accuracy (95.1%) of DUS in evaluating arterial injuries at 1 month correlated well with histopathologic evaluation. All arteries subjected to crush injuries showed abnormal duplex findings. These findings correlated well with the histologic picture of severe injury (arterial wall thickness = 2.72 × ± 0.23 × control; intramural hemorrhage, 93%; mural thrombus, 60%). DUS and histologic study revealed healing of intimal flaps in 27% of the arteries. Other intimal flaps deteriorated (stenoses, 47%; dilation, 13%; occlusion, 13%). Most lacerations (86%) revealed duplex evidence of healing within 10 days of injury. This was confirmed by histologic study at 1 month in 73% of lacerated arteries. This study confirms the accuracy of DUS in diagnosing various arterial injuries and shows that the natural history of these injuries varies with the mechanism of injury. Arterial injuries with benign characteristics on DUS may not require repair; however, those with intramural hemorrhage, obstructing intimal defects, or progressive stenosis associated with increasing wall thickness may require repair. These data suggest a role for the nonoperative treatment of clinically occult arterial injuries based on duplex characteristics, and they indicate a need for clinical trials.

UR - http://www.scopus.com/inward/record.url?scp=0026676642&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026676642&partnerID=8YFLogxK

U2 - 10.1016/0741-5214(92)90049-E

DO - 10.1016/0741-5214(92)90049-E

M3 - Article

C2 - 1460713

AN - SCOPUS:0026676642

VL - 16

SP - 867

EP - 876

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 6

ER -