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November 28, 1977

Evaluation of Trauma With Angiograph

JAMA. 1977;238(22):2366. doi:10.1001/jama.1977.03280230030007

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To the Editor.—  In two angiograms shown by Redman (237:2415-2418, 1977), spasm was diagnosed in a brachial artery (her Fig 1) and in an axillary artery (her Fig 2). The minimal narrowing in these two angiograms could have been due to hematoma or soft tissue swelling.It cannot be denied that large arteries may go into spasm because of their intrinsic musculature, but arterial spasm is a dangerous diagnosis to make when there is trauma. It is convenient but hazardous for the physician who does not feel pulses in an extremity distal to an injury or who notes pallor and coolness to conclude that these findings are due to arterial spasm. This is particularly true in blunt trauma. Spasm may also be diagnosed on an arteriogram, particularly in cases of blunt trauma, but in my experience there has been contusion or intimal disruption in all such cases rather than spasm.