Vascular radiological procedures in orthopedic surgery.

Abstract

Angiographic procedures are valuable in the analysis of trauma, postoperative situation, congenital lesions, tumors, and vascular conditions producing bone and soft tissue alterations. Angiography following trauma is most helpful in determining the status of the integrity of vessels when the clinical findings are not clear, when a vascular lesion without obstruction is suspected, to establish the status of distal vessels following repair of a proximal injury and to evaluate multiple injuries in the same limb. Vascular damage is possible even when the overlying soft tissue has not been lacerated. Embolization techniques to control hemorrhage have been recently developed. Immediate or delayed effects of intraoperative damage to the vessels can be verified by angiography. Most commonly traumatic arteriovenous communications and pseudoaneurysms are discovered by angiographic means. Congenital vascular lesions may be classified as localized arteriovenous malformations, small vessel arteriovenous malformations, diffuse arteriovenous malformations, or venous malformations. Angiography localizes and defines the extent of such lesions. Skeletal or muscular congenital anomalies secondarily involving the vessels can best be defined by angiographic means. Angiography of tumors is most helpful in defining the location and extent of tumors and the site for most productive biopsy. With rare exceptions, the angiogram is not helpful in defining the histologic nature of the lesion. The angiographic studies are most helpful in lesions involving the pelvis and retroperitoneal spaces. Vascular diseases producing bone and soft tissue alterations can best be defined as to extent by angiographic means. In particular, the diabetic patient with limb ischemia should be afforded the benefit of an arteriogram to establish the presence or absence of any surgically remedial lesions in the proximal vascular supply to the limb.