The Value of Aortic Flush Angiography in Detecting Potential Pedal Run-off Vessels in Diabetics

Abstract

Background: The purpose of this retrospective study is to compare nonselective angiography of the pedal vascular system in diabetics with intraoperative findings and operative results. Methods: The study cohort consisted of 42 consecutive patients (33 men, 9 women; median age: 70) who underwent 45 attempted pedal bypasses to treat critical pedal ischaemia. All patients had nonselective angiograms performed by injecting contrast medium at the level of the aortic bifurcation. Without knowledge about the operative results, pedal vessel imaging was retrospectively categorized on a scale from I to V (category I, angiographically disease-free artery; category V, angiographically undetected vessel). Results: Fourteen angiograms demonstrated at least one pedal vessel categorized as either I, II or III (Group A). All these arteries proved to be suitable for pedal bypass intraoperatively. Thirty-one angiographies were classified as either IV or V (Group B). Despite the angiographic findings, 28 of the patients in Group B demonstrated a patent pedal artery at surgery, and a bypass procedure was completed. Secondary patency at 2 years showed no statistically significant difference between the two groups (78.5 % for Group A vs. 76.4 % for Group B). Conclusions: In case of limb-threatening diabetic macroangiopathy, aortic flush angiography fails to demonstrate patent pedal vessels reliably and should not be used to exclude patients from pedal bypass procedures.