Natural history of arterial injuries diagnosed with arteriography

PURPOSE: To evaluate the natural history of untreated arterial injuries identified at arteriography.

MATERIALS AND METHODS: The medical charts and radiographs were reviewed for all patients with arterial injuries identified during arteriography who were managed by means of nonoperative observation and underwent follow-up arteriography.

RESULTS: Eighty-six nonrandomized patients with 105 arterial injuries were identified. These included 33 narrowed segments, two dilated segments, 23 intimal defects, 13 occlusions, 12 false aneurysms, 13 arteriovenous fistulas (AVFs), and five extravasations. Four vessels initially considered normal were subsequently found to have injuries. The average duration of observation was 23.5 days (range, 1-1,900 days). Forty-two arterial abnormalities healed spontaneously without other intervention. Thirty-eight "minimal" injuries improved or healed, whereas 25 worsened. Thirteen transmural injuries improved, whereas 12 progressed. There was no significant morbidity or mortality due to the delay involved with sequential studies.

CONCLUSIONS: The natural history of these abnormalities was variable and unpredictable. Nonocclusive "minimal" injuries rarely cause ischemic or hemorrhagic complications. Although symptomatic AVFs have a low probability of spontaneous resolution, asymptomatic lesions may close and the risks associated with a few months of observation are minimal. Close follow-up is essential if a nonoperative approach is undertaken.