Alt ekstremite arter travması

Özet

Künt veya penetran alt ekstremite travmasında damar yaralanması; kırık, çıkık, ezilme ya da damar seyri boyunca ilerleyen yara ile birlikte görülebilir. Arteriyel BTA, duvar hasarının yerini ve distal akımı tek incelemede gösterirken kemik penceresi ve yumuşak dokular yaralanma mekanizmasını açıklar. İntimal hasar, tromboz, psödoanevrizma, arteriyovenöz fistül ve tam kesilme farklı görünüm ve distal dolaşım sonuçları doğurur. Yaralanma düzeyinin veya distal akım kaybının atlanması, akut iskemi ve kanama kontrolünün gecikmesine neden olabilir.

Faz ve pencere

BTA tanısal

Arteriyel BTA'da damar boyunca ani kaliber değişikliği, intimal düzensizlik/flep, lümen içi trombüs, kesinti, psödoanevrizma, aktif kontrast ekstravazasyonu veya eşzamanlı erken venöz doluş aranır. MPR ve MIP rekonstrüksiyonlarını ekstremite damar travmasını değerlendirmek için kullanın; damar kesintisini distal opasifikasyon kaybı ve eşlik eden kırık/çıkıkla birlikte inceleyin.

Gecikmiş tanısal

Seçilmiş olgularda gecikmiş seri, arteriyel fazda damar dışına çıkan kontrastın büyüyüp yayılmasını göstererek devam eden kanamayı sınırlı psödoanevrizma veya damar dışı yoğun içerikten ayırmaya yardım eder.

Önerilen pencereler: Anjiyo (G 600 / M 150), Yumuşak doku (G 400 / M 40), Kemik (G 1800 / M 400).

BT bulguları

• İntimal flep — kontrastlı lümen içinde ince lineer membran, düzensiz daralma veya flebin distalinde trombüs.
• Travmatik stenoz — yaralanma seviyesinde ani lümen daralması; proksimal ve distal sağlam segmentlerle kıyaslanır.
• Arteriyel oklüzyon — opasifikasyonun kesildiği segment ve distal damarlarda azalma/yokluk; kollateral yeniden doluş olabilir.
• Tam kesilme — damar konturunun kesintiye uğraması, uçların retraksiyonu, distal akım kaybı ve sıklıkla çevre hematom.
• Aktif ekstravazasyon — lümen dışındaki kontrast odağı arteriyel seriyle eş zamanlı dolup gecikmiş seride genişler.
• Travmatik psödoanevrizma — arterle bağlantılı sınırlı kontrastlanan kese; çevre hematomla birlikte olabilir.
• Arteriyovenöz fistül — arteriyel fazda komşu venin erken opasifikasyonu ve arter-ven arasında anormal bağlantı şüphesi.
• İskelet ve distal akım — kırık/çıkığın damar yaralanmasıyla hizası ve popliteal-tibial-ayak arterlerine kadar opasifikasyon.

Normalde

Normal ekstremite BTA'sında iliak-femoral, popliteal ve tibial arterler kesintisiz, düzgün konturlu kontrastla dolar; karşı taraf damarları distal opasifikasyon için iç kontrol sağlar. Yaralı seviyede intimal düzensizlik, ani kesilme veya damar dışı kontrastı karşı tarafla ve aynı damarın sağlam proksimal-distal bölümleriyle kıyaslayın; kırık çizgisiyle anatomik komşuluğu ayrıca kurun.

Ayırıcı tanı

Vazospazm

düzgün ve kısa segment daralma yapabilir; intimal flep, duvar dışı kanama veya çevre hematom bulunmayabilir.

Kronik aterosklerotik stenoz

aterosklerotik periferik arter oklüzif hastalığı BTA ile değerlendirilir.

Kontrast zamanlama hatası

damar yatağında yaygın zayıf opasifikasyon görülür; tek odaklı kesilme izlenimi distal geç doluşla değişebilir.

Popliteal arter tuzaklanması

diz arkasındaki darlık anormal gastroknemius veya tendon ilişkisiyle açıklanır; travmatik duvar hasarı gerektirmez.

Arteriyel psödoanevrizma

travma sonrası oluşabilir; devam eden serbest ekstravazasyondan farklı olarak sınırlı kese şeklinde kontrastlanır.

Tuzaklar

• Tüm ekstremitede zayıf opasifikasyonu çoklu oklüzyon sanmayın; erken tarama zamanlaması ve düşük debiye bağlı yetersiz arteriyel doluşu göz önünde bulundurun.
• Metal artefaktı veya kemik fragmanını intimal flep gibi değerlendirmeyin; damar lümenini ardışık kesit ve farklı düzlemde doğrulayın.
• Tam kesilme görünümünde distal damarların kollateral doluşunu yaralanmayı dışlayan bulgu saymayın; kopma seviyesini ve uçları ayrıca gösterin.
• Tek arteriyel seride sınırlı kontrast havuzunun psödoanevrizma mı aktif kanama mı olduğu belirsizse gecikmiş seride boyut ve dağılım değişimini inceleyin.

Kendini dene

1. Diz çevresi kırık sonrası BTA'da popliteal arterde ani kesinti, distal opasifikasyon kaybı ve çevre hematom var. En olası yaralanma nedir?

   • Arteriyel kesilme
   • Vazospazm
   • Aterosklerotik stenoz
   • Popliteal tuzaklanma
   Cevabı göster

   Arteriyel kesilme. Ani damar kesintisi, distal akım kaybı ve çevre hematom kesilme tanısını destekler. Vazospazm düzgün daralma yapabilir; aterosklerozda plak izlenir; tuzaklanmada anormal kas-arter ilişkisi bulunur.

2. Penetran uyluk yaralanmasında sınırlı kontrastlanan kese ve arterle dar bir bağlantı görülüyor. En uygun tanı nedir?

   • Psödoanevrizma
   • Aktif ekstravazasyon
   • Arteriyovenöz fistül
   • Vazospazm
   Cevabı göster

   Psödoanevrizma. Arterle boyun üzerinden bağlantılı sınırlı kese psödoanevrizmadır. Aktif ekstravazasyon gecikmiş seride yayılabilir; fistülde erken ven doluşu, vazospazmda ise fokal düzgün daralma beklenir.

Kaynaklar

Bu sayfadaki 39 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 5 cümle bu karşılaştırmada düzeltildi (2026-10-08).

1. CTA Imaging of Peripheral Arterial Injuriespmc.ncbi.nlm.nih.gov
2. Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of Trauma practice management guideline.pubmed.ncbi.nlm.nih.gov
3. Epidemiology, Etiology, and Pathophysiology of Pulmonary Embolism.pubmed.ncbi.nlm.nih.gov
4. Pseudoaneurysms in haemophilia.pubmed.ncbi.nlm.nih.gov
5. Penetrating injury to the buttock: an update.pubmed.ncbi.nlm.nih.gov
6. Imaging vascular trauma.pubmed.ncbi.nlm.nih.gov
7. [Vascular injuries in joint replacement surgery].pubmed.ncbi.nlm.nih.gov
8. Lower Limb Paralysis as Initial Presentation of Arterial Embolism Secondary to Heparin-Induced Thrombocytopenia after Hip Fracture - a Case Report.pubmed.ncbi.nlm.nih.gov
9. Bilateral vertebral artery transection following blunt trauma.pubmed.ncbi.nlm.nih.gov
10. Neurovascular Compression Caused by Popliteus Muscle Enlargement Without Discrete Trauma.pubmed.ncbi.nlm.nih.gov
11. CT angiography of the lower extremities.pubmed.ncbi.nlm.nih.gov
12. A Middle-Aged Woman With Hematochezia, Hypotension, and Leg Cramps.pubmed.ncbi.nlm.nih.gov
13. The Medial Sural Artery Perforator Flap in Lower Extremity Reconstruction.pubmed.ncbi.nlm.nih.gov
14. Complete Erosion of an Aortobifemoral Bypass Graft Limb into Duodenum.pubmed.ncbi.nlm.nih.gov
15. Late-Onset Development of Compartment Syndrome Following Penetrating Extremity Trauma With Vascular Injury: A Case Report.pubmed.ncbi.nlm.nih.gov
16. Penetrating Ballistic Trauma to the Popliteal Fossa Without Neurovascular Injury Despite High-Risk Trajectory: An Unusual Case Report.pubmed.ncbi.nlm.nih.gov
17. Proximal and distal endovascular embolization of a penetrating V3 vertebral artery transection with adjunctive surgical ligation: A case report.pubmed.ncbi.nlm.nih.gov
18. Tibial Bone Transcortical Erosion Caused by a Posterior Tibial Artery Pseudoaneurysm: A Rare Case Report.pubmed.ncbi.nlm.nih.gov
19. Case Report: Life-saving external hemipelvectomy after missed external iliac artery occlusion in severe pelvic trauma.pubmed.ncbi.nlm.nih.gov
20. Superficial femoral artery thrombosis after PFNA in an intertrochanteric fracture patient with sarcopenia and copd: a rare case report.pubmed.ncbi.nlm.nih.gov
21. CTA Imaging of Peripheral Arterial Injuries.pubmed.ncbi.nlm.nih.gov
22. Imaging of cerebrovascular complications from blunt skull base trauma.pubmed.ncbi.nlm.nih.gov
23. Neuroendovascular Surgery Applications in Craniocervical Trauma.pubmed.ncbi.nlm.nih.gov
24. Ischemia Duration and Lower Limb Salvage.pubmed.ncbi.nlm.nih.gov
25. Artificial Intelligence for Computer-Aided Detection in Endovascular Interventions: Clinical Applications, Validation, and Translational Perspectives.pubmed.ncbi.nlm.nih.gov
26. Delayed presentation of complete arterial transection treated with interposition graft: A case report.pubmed.ncbi.nlm.nih.gov
27. MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management-A Reappraisal.pubmed.ncbi.nlm.nih.gov
28. Multi-Detector Computed Tomography Imaging Techniques in Arterial Injuries.pubmed.ncbi.nlm.nih.gov
29. Acute aortic syndromes and aortic emergencies.pubmed.ncbi.nlm.nih.gov
30. Long-term safety and effectiveness of the "OptEase" vena cava filter.pubmed.ncbi.nlm.nih.gov
31. Neuroimaging for neurovascular complications of traumatic brain injury.pubmed.ncbi.nlm.nih.gov
32. The mechanism and therapy of aortic aneurysms.pubmed.ncbi.nlm.nih.gov
33. Emergent Endovascular Stent Grafts for Ruptured Aortic Aneurysms.pubmed.ncbi.nlm.nih.gov
34. Spontaneous isolated celiac artery dissection mimicking gastrointestinal stromal tumor and causing upper gastrointestinal hemorrhage: a case report.pubmed.ncbi.nlm.nih.gov
35. Middle cerebral artery dissection: pathophysiology, diagnosis, and therapeutic options.pubmed.ncbi.nlm.nih.gov
36. Operative Procedures for Ultrasound Assessment of Extracranial Artery Disease: A Narrative Review by the Italian Society for Vascular Investigation (SIDV).pubmed.ncbi.nlm.nih.gov
37. Clinical Decision-Making and Imaging-Guided Follow-Up Strategies in Spontaneous Coronary Artery Dissection.pubmed.ncbi.nlm.nih.gov
38. Chest Discomfort: Could Coronary Pathology Extend Beyond Atherosclerosis?pubmed.ncbi.nlm.nih.gov
39. Neurosonology in acute stroke revealing bilateral internal carotid artery occlusion maintained by persistent embryologic collaterals: A case report.pubmed.ncbi.nlm.nih.gov
40. Computed Tomography Angiography Recognition of a Hemorrhagic Moyamoya Pattern May Alter Acute Blood Pressure Management.pubmed.ncbi.nlm.nih.gov
41. Severe Pediatric Takayasu Arteritis Presenting With Cerebral Ischemia and Supra-Aortic Trunk Occlusion.pubmed.ncbi.nlm.nih.gov
42. Combined Post-traumatic Pseudoaneurysms of the Superior Gluteal and Aberrant Obturator Arteries: A Case Report.pubmed.ncbi.nlm.nih.gov
43. Pitfall in necrotizing pancreatitis: Organized hematoma with arteriovenous fistula mimicking a splenic artery pseudoaneurysm.pubmed.ncbi.nlm.nih.gov
44. Delayed rupture of right external iliac artery pseudoaneurysm after removal of foreign body from small intestine: a case report.pubmed.ncbi.nlm.nih.gov
45. Atherosclerotic Abdominal Aortic Aneurysms on Computed Tomography Angiography: A Narrative Review on Spectrum of Findings, Structured Reporting, Treatment, Secondary Complications and Differential Diagnosis.pubmed.ncbi.nlm.nih.gov
46. Intracerebral Hemorrhage Caused by the Rupture of a Traumatic Pseudoaneurysm in the Middle Meningeal Artery.pubmed.ncbi.nlm.nih.gov
47. Balloon-assisted endovascular embolization of a subcutaneous penile arteriovenous fistula using a quadruple coaxial system: A case report.pubmed.ncbi.nlm.nih.gov
48. Co-occurring scalp arteriovenous malformation and dural arteriovenous fistula with diploic vein involvement: illustrative case.pubmed.ncbi.nlm.nih.gov
49. Exploration of Spontaneous Coronary Artery Dissection: Pathophysiology, Diagnosis, Management, and Clinical Implications.pubmed.ncbi.nlm.nih.gov
50. Cannabis-Associated Spontaneous Coronary Artery Dissection in a Community Hospital: A Case-Based Focused Literature Review.pubmed.ncbi.nlm.nih.gov
51. Cardiac CT in the Era of Precision Cardiology: From Calcium Scoring to Comprehensive Risk Profiling.pubmed.ncbi.nlm.nih.gov
52. Intravascular Imaging to Predict the Coronary No-Reflow and Slow-Flow Phenomena: Advances and Perspectives.pubmed.ncbi.nlm.nih.gov
53. From incidental positron emission uptake to <i>in-vivo</i> phenotyping: a short history of positron emission tomography in the study of atherosclerosis and the vulnerable plaque.pubmed.ncbi.nlm.nih.gov
54. Contrast opacification on thoracic CT angiography: challenges and solutions.pubmed.ncbi.nlm.nih.gov
55. Pulmonary MRA: differentiation of pulmonary embolism from truncation artefact.pubmed.ncbi.nlm.nih.gov
56. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
57. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
58. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
59. Optimal approach to performing and reporting computed tomography angiography for suspected acute pulmonary embolism: a clinical consensus statement of the ESC Working Group on Pulmonary Circulation & Right Ventricular Function, the Fleischner Society, the Association for Acute CardioVascular Care (ACVC) and the European Association of Cardiovascular Imaging (EACVI) of the ESC, endorsed by European Respiratory Society (ERS), Asian Society of Thoracic Radiology (ASTR), European Society of Thoracic Imaging (ESTI), and Society of Thoracic Radiology (STR).pubmed.ncbi.nlm.nih.gov
60. Radiologic evaluation of the kidney transplant donor and recipient.pubmed.ncbi.nlm.nih.gov
61. Imaging of renal emergencies: Review of infectious, hemorrhagic, vascular, and traumatic etiologies.pubmed.ncbi.nlm.nih.gov
62. Mechanisms of aortic dissection: From pathological changes to experimental and <i>in silico</i> models.pubmed.ncbi.nlm.nih.gov
63. Spontaneous bacteremia and spontaneous bacterial peritonitis share similar prognosis in patients with cirrhosis: a cohort study.pubmed.ncbi.nlm.nih.gov
64. Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.pubmed.ncbi.nlm.nih.gov
65. High-affinity alphavbeta3 integrin targeted optical probe as a new imaging biomarker for early atherosclerosis: initial studies in Watanabe rabbits.pubmed.ncbi.nlm.nih.gov
66. CT of Penetrating Abdominopelvic Trauma.pubmed.ncbi.nlm.nih.gov
67. Fluid transport in the brain.pubmed.ncbi.nlm.nih.gov
68. Total laparoscopic radical hysterectomy for cervical cancer in prolapsed uterus.pubmed.ncbi.nlm.nih.gov
69. Extravertebral low back pain: a scoping review.pubmed.ncbi.nlm.nih.gov
70. Imaging of the Posttreatment Head and Neck: Expected Findings and Potential Complications.pubmed.ncbi.nlm.nih.gov
71. Endovascular Considerations in Traumatic Injury of the Carotid and Vertebral Arteries.pubmed.ncbi.nlm.nih.gov
72. Indian College of Radiology and Imaging Consensus Guidelines on Interventions in Pancreatitis.pubmed.ncbi.nlm.nih.gov
73. Roles of Trauma CT and CTA in Salvaging the Threatened or Mangled Extremity.pubmed.ncbi.nlm.nih.gov
74. A multimodality review of male urethral imaging: pearls and pitfalls with an update on urethral stricture treatment.pubmed.ncbi.nlm.nih.gov
75. Bilateral anterior tibial artery pseudoaneurysms triggered by minor blunt trauma as the initial presentation of vascular Ehlers-Danlos syndrome with a whole-exon deletion.pubmed.ncbi.nlm.nih.gov
76. Traumatic common iliac artery occlusion mimicking acute sciatica: a case report.pubmed.ncbi.nlm.nih.gov
77. Predictors of the need for angioembolization in blunt pelvic trauma.pubmed.ncbi.nlm.nih.gov
78. Digital Ischemia as a Rare Initial Presentation of Myeloperoxidase (MPO)-Anti-neutrophil Cytoplasmic Antibody (ANCA)-Positive Granulomatosis With Polyangiitis: A Case Report.pubmed.ncbi.nlm.nih.gov
79. An Overview of the Diagnostic and Treatment Strategies for Aortic Disease.pubmed.ncbi.nlm.nih.gov
80. Acute Limb Ischemia During Pregnancy: A Case Report and Narrative Review of the Literature.pubmed.ncbi.nlm.nih.gov
81. Popliteal artery aneurysm with popliteal artery entrapment syndrome: a case report and literature review.pubmed.ncbi.nlm.nih.gov
82. Aneurysm of a Supra-Articular Branch of the Popliteal Artery Mimicking a Soft-Tissue Sarcoma: A Case Report.pubmed.ncbi.nlm.nih.gov
83. Pseudoaneurysm of the Medial Genicular Artery as a Rare Cause of Recurrent Knee Swelling - A Case Report.pubmed.ncbi.nlm.nih.gov
84. Stroke and its consequences: protocol and pilot data of the observational Berlin Long-term Observation of Vascular Events (BeLOVE) stroke stratum.pubmed.ncbi.nlm.nih.gov
85. CT Angiography of the Upper Extremities: Review of Acute Arterial Entities.pubmed.ncbi.nlm.nih.gov
86. Society for Cardiovascular Magnetic Resonance 2024 Cases of SCMR case series.pubmed.ncbi.nlm.nih.gov
87. Coral reef aorta in a child: a case report.pubmed.ncbi.nlm.nih.gov
88. Coronary artery disease imaging with total-body PET.pubmed.ncbi.nlm.nih.gov
89. Vertebral Artery Pseudoaneurysm in a Single-Vessel Posterior Circulation With Chronic Contralateral Occlusion and Recent Methamphetamine Use.pubmed.ncbi.nlm.nih.gov
90. Fibromuscular Dysplasia: A Focused Review for the Cardiologist.pubmed.ncbi.nlm.nih.gov
91. Neurological complications post aortic arch surgery: a state of art review.pubmed.ncbi.nlm.nih.gov
92. An updated meta-analysis of prognostic factors for secondary amputation following surgical repair of lower-extremity vascular trauma in both civilian and military populations.pubmed.ncbi.nlm.nih.gov
93. Femoral Vein Reconstruction for Aortic Infections.pubmed.ncbi.nlm.nih.gov
94. Vascular and lymphatic complications after renal transplant.pubmed.ncbi.nlm.nih.gov
95. Fractures and dislocations of the foot and ankle in people with diabetes: a literature review.pubmed.ncbi.nlm.nih.gov
96. Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition).pubmed.ncbi.nlm.nih.gov
97. Polyvascular Atherosclerotic Disease: A Narrative Review of the Role of Systematic Bedside Vascular Examination.pubmed.ncbi.nlm.nih.gov
98. Evaluation of Atherosclerotic Changes in the Superior Mesenteric Artery Using MDCT.pubmed.ncbi.nlm.nih.gov
99. Diagnostic pitfalls of computed tomography angiography in high-energy knee trauma: two case reports on complete popliteal artery transection despite preserved distal flow.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.