Chronic arterial occlusions of the lower extremities; an arteriographic study of 62 cases.

Abstract

For many years past arteriography has been an established procedure in the study of the circulation of the lower extremities. It has been frequently employed in Europe but its use in the United States has been exceptional and thus, if we exclude the initial works of Allen and others (1) and the later publications of Smith and Campbell (2, 3), the reports on this method have been few and isolated. With the improvement of radiopaque substances and the progress of the technic of roentgenography, this method of exploration has attained a high level of perfection. Leriche (4), dos Santos (5), Reboul (6), Lindbom (7) and others (8, 9) have indicated its advantages in the study of alterations in the circulation of the extremities. One of the reasons adduced for not utilizing arteriography is that it does not furnish any data that cannot be obtained by simpler methods involving less danger to the patient. Our experience is not in accord with this view. In support of our position we present an analysis of 62 arteriograms obtained in cases in which one of the arteries of the lower extremities was occluded in order to determine the possible advantages of the procedure. Material and Methods During the last two years arteriography has been carried out in the majority of patients entering the Department of Vascular Diseases at the Havana University Hospital. For the purposes of this article we have selected only those cases with the following characteristics: (1) occlusion of one of the principal arteries of the lower extremities; (2) arteriograms sufficiently clear to allow a detailed study of the arteries of the leg and thigh; (3) an etiological diagnosis either clinically evident or shown by histologic examination of the arteries in doubtful cases; (4) knowledge of the subsequent course of the patient's illness. After this selection, it was possible to separate 62 arteriograms from a total of 123. All the patients underwent the same general methods of treatment, and none showed symptoms of acute arterial occlusion, since in such circumstances we do not utilize arteriography, as we consider it harmful. Technic: The puncture of the femoral artery was made at the level of the crural arch, with a No. 18 needle. When the femoral pulse is not felt, it is because the occlusion is higher, at the level of the iliac or the aorta, and an aortogram is necessary to visualize the occluded segment. No special care was taken to direct the point of the needle upward or downward, no case having been encountered in which the puncture has been made over the deep femoral artery, as has been mentioned by some (7). The radiopaque substance utilized was Diodrast. In the first cases a 70 per cent solution was employed, but later solutions of 50 or 35 per cent were used. Between 30 and 50 c.c, was injected by means of an apparatus under positive pressure of 30 pounds per square inch, the injection being completed in five or six seconds.