Catheter angiography may be an unnecessary follow-up to CT angiography

Even in challenging cases, CT angiography (CTA) offers an accurate and rapid diagnosis for blunt trauma victims who may have aortic or great vessel injury negating the need for more invasive procedures, according to a recent study conducted by radiologists at the University of Washington and the Harborview Injury Prevention and Research Center in Seattle, WA.

CTA is commonly used to rule out blunt aortic and intrathoracic great vessel injuries, but sometimes the results are indeterminate, said Marla Sammer, MD, lead author of the study. When the results are indeterminate, a subsequent catheter angiography is usually performed.

“Aortic injury is a significant cause of morbidity and mortality following blunt trauma, especially motor vehicle collisions. If aortic injury is not diagnosed quickly, morbidity and mortality are significantly increased,” CT angiography offers a much more rapid diagnosis than traditional catheter aortography, and it is noninvasive. Given these potential significant benefits, we undertook this study to determine if patients can be spared catheter angiogram when the CT angiogram is indeterminate for aortic injury,” Dr. Sammer said.

The study consisted of 72 patients who had bleeding and other injuries around the aorta who underwent both CTA and invasive catheter angiography. The CTA results were noted as being indeterminate. Of the 72 patients, no aortic injuries were missed by CTA.

Our study adds to the growing evidence that catheter angiography may be unnecessary in cases where the CT angiogram is indeterminate for aortic injury,” Dr. Sammer said.

“If CT angiography is used alone, the patient can be spared an invasive catheter angiogram, risks of which include vascular injury, hemorrhage, infection, and even death,” said Dr. Sammer. “Furthermore, since patients with suspected aortic injury often have multiple other life threatening injuries, the time that would be spent performing the catheter angiogram can be used instead to more rapidly diagnosis and treat other injuries.