541 - Early Venous Enhancement on CT Angiography in Lower-Extremity Trauma: Associations with Tourniquet Use and Vascular Injury

Monday, April 13, 2026

12:10 PM - 1:10 PM ET

Poster Presenter(s)

DB

Dana Brin, MD

Resident
Department of Diagnostic Imaging, Chaim Sheba Medical Center, Israel

Author/Co-author(s)

DR

Daniel Raskin, MD

Interventional radiologist
Interventional Radiology Division, Cleveland Clinic, United States
EG

Efrat Keren Gilat, MD

Radiology resident
Department of Diagnostic Imaging, Chaim Sheba Medical Center, Israel
MK

Matan Kraus, MD

Radiology resident
Department of Diagnostic Imaging, Chaim Sheba Medical Center, Israel
AR

Ariel Rauchwerger, MD

Radiology resident
Department of Diagnostic Imaging, Chaim Sheba Medical Center, Israel
JT

Jonathan Tihanyi, MD

Radiology resident
Department of Diagnostic Imaging, Chaim Sheba Medical Center, Israel
VS

Vera Sorin, MD

Radiology Fellow
Department of Radiology, Mayo Clinic, United States
BK

Boris Khaitovich, MD

Head of Interventional radiology unit
Department of Diagnostic Imaging, Chaim Sheba Medical Center, Israel
EK

Eli Konen, MD

Head of Diagnostic Radiology Department
Department of Diagnostic Imaging, Chaim Sheba Medical Center, Israel
IC

Israel Cohen, MD

Interventional Radiology Fellow
Department of Diagnostic Imaging, Chaim Sheba Medical Center, Israel

Purpose: Lower-extremity vascular trauma carries high morbidity, including risk of limb loss. Computed tomography angiography (CTA) is the preferred initial imaging modality, enabling rapid evaluation of arterial integrity. Occasionally, arterial-phase CTA reveals early venous enhancement (EVE), a finding linked to arteriovenous fistula (AVF) in some cases. However, in the absence of a visible AVF, the clinical significance of EVE remains uncertain.

We aimed to evaluate the clinical significance of EVE on arterial-phase CTA in patients with acute lower-extremity trauma.

Materials and Methods: This retrospective study included adult patients with lower-extremity trauma who underwent CTA within 24 hours of injury between January 2020 and January 2025 at a level I trauma center. EVE was defined as asymmetric enhancement of deep veins on arterial-phase imaging relative to the contralateral limb. Patient demographics, injury characteristics, tourniquet use, vascular injuries, and complications were recorded. Multivariable logistic regression was used to identify factors independently associated with EVE.

Results: Among 101 patients (154 injured limbs), EVE was present in 27 limbs (17.5%). Tourniquet was applied in 72/154 limbs (46.8%) and was independently associated with EVE (aOR 5.95, 95% CI 1.77–20.00, p=.004). Visible vascular injury on CTA was not independently associated with EVE (aOR 0.43, 95% CI 0.14–1.27, p=.126). EVE showed no association with major complication (OR 2.31, p=.124) or persistent vascular injury at follow-up (OR 2.13, p=.383). Interobserver agreement for EVE was almost perfect (κ=0.913, p< .001).

Conclusion: EVE on arterial-phase CTA is significantly associated with prior tourniquet use but is not independently associated with acute vascular injury.