Abstract No. 146 A retrospective study on clinical outcomes of diagnostic angiograms executed via 3Fr inner dilator access

Abstract

5Fr sheaths (actual external diameter 7Fr) are generally employed as the formal access for lower extremity angiograms. At our institution we have demonstrated successful execution of angiograms with safe clinical outcomes using 3Fr inner dilators. Benefits to this technique include potential lower risk of complications and decreased patient immobilization. The purpose of this study is to review the utility and clinical outcomes of diagnostic angiograms conducted via 3Fr inner dilator. An intra-institutional retrospective review of patients who underwent lower extremity angiogram during the last 4 years was conducted. Patients were eligible for analysis if they had undergone diagnostic angiography using a 3Fr inner dilator. Patients were excluded from the study in the setting of upsizing catheter access, bilateral angiography, or arterial interventions immediately post-procedure. Data points including indication for angiogram, amount of radiopaque contrast used, dose of external radiation, blood loss were gathered. Amount of contrast used and radiation exposure were averaged. Postprocedural arterial complications, specifically access-site pseudoaneurysm, hematoma, and severe access site pain within 30 days post-angiogram were recorded. 32 patients were eligible for the study. Observed indications for angiography included peripheral vascular disease or Arteriovenous malformation workup, lower extremity trauma or infection, and surgical free flap planning. Average amount of contrast used was 42.8 ± 12.1 mL. Average radiation exposure was 116.4 ± 81.0 mGy. No procedure-related complications were observed in any of the patients. While 50% of angiograms were unremarkable for arterial disease, this technique yielded pathology such as stenosis, complete occlusion, and vascular injury. It is quite suitable and beneficial to conduct diagnostic angiograms with 3Fr inner dilators. Indeed, in the setting of an unremarkable unilateral diagnostic angiogram, the aforementioned method provides adequate diagnostic information while providing the added benefit of minimal complication rate and reduced patient immobility. Our group concludes that 3Fr inner dilator is a plausible initial approach to unilateral diagnostic angiography and upsizing to a 5Fr catheter is only necessary in the setting of added therapeutic intervention.