Some considerations in the patient with a penetrating vascular injury (gunshot, stab):

• Obtain ankle-brachial index on all patients and document
• An ABI <0.9 indicates the need to perform an arterial study
• Traditional approach to penetrating extremity injury has been to perform angiography
• Recent (good) studies have shown that CTA of the involved extremity is just as good if not better than angiography, and a lot of centers have moved to CTA
• Obtain vascular surgery consultation if there is any concern for an arterial injury. Never hurts to err on the side of caution. 

References

 

Am Surg. 2008 Feb;74(2):103-7.

CT angiography effectively evaluates extremity vascular trauma.

Peng PD, Spain DA, Tataria M, Hellinger JC, Rubin GD, Brundage SI.