Digital subtraction angiography in preoperative examination of congenital hand malformations

Abstract

Since 1971, we have carried out in our department systematic angiographic research on cases of congenital hand deformities to determine how the vascular pattern takes part in the global anatomic deformity of the malformed hand.” 2 From our point of view, proper evaluation of the blood supply is important to classify the congenital malformation, complete the patient’s documentation, and select the correct surgical planning when treating a malformed hand. Since 1981, we have performed a digital subtraction angiography technique that has well-known advantages over traditional techniques: it allows better visualization, provides a real-time hemodynamic evaluation, uses lower doses of contrast medium, and gives the possibility to register the entire examination on a magnetic tape.3-9 Technique. In children under 14 years of age, we prefer to perform the examination under general anesthesia; in older patients a brachial plexus block, if indicated, can be performed. To prevent allergic reactions, 4 mg of betamethasone sodium phosphate is given intravenously the evening before the test; the day of the examination 1.5 mg of betamethasone sodium phosphate and 10 mg of chlorpheniramine maleate are given intravenously. The contrast medium used is iodated or noniodated (iopamidol or iohexol). The humeral artery is exposed at the elbow to avoid problems relating to percutaneous injections such as hematomas, intimal damage, infiltration of contrast medium in the forearm’s soft tissues, and damage to the median nerve. If ex-