Peripheral Arteriography Research Articles

Anatomic and Clinical Factors Associated with Complications of Transfemoral Arteriography

Complications of transfemoral arteriography requiring surgery are rare but carry significant morbidity. To evaluate clinical factors that might relate to such complications, we retrospectively reviewed our experience from January 1, 1985, to December 31, 1988 (four years). Forty-seven complications requiring surgery occurred among 10,589 cases. The risk was higher after cardiac catheterization than after peripheral arteriography (0.55% versus 0.17%, p less than 0.025). In nearly 40% of these cases, arterial puncture was not in the common femoral artery. Acute bleeding complications were more likely among patients with puncture outside the common femoral artery (p less than 0.001). Older patients and women were at slightly higher risk for complications requiring surgery, but this difference was not statistically significant. The frequency of bleeding complications was not significantly higher among patients who were anticoagulated following the procedure. The distribution of puncture sites was identical in obese and nonobese patients. Three patients died (two from myocardial infarction, one from multisystem organ failure). Two limbs did not improve; one required major amputation. Four limbs had persistent paresthesia and two had persistent weakness. We conclude that complications of transfemoral arteriography requiring surgery occur more frequently among patients who are undergoing cardiac catheterization and who suffer aberrant punctures. Age, sex, body habitus, and anticoagulation have less impact on patient risk.

Peripheral arterial occlusive disease: P-31 MR spectroscopy of calf muscle.

The effect of a graded exercise protocol on phosphorus-31 magnetic resonance (MR) spectroscopy of calf skeletal muscle in nine healthy (control) subjects and 16 patients with symptomatic peripheral arterial occlusive disease (PAOD) was assessed. Ankle-brachial pressure indexes were obtained in all 16 patients, and 10 patients underwent peripheral arteriography. Temporal profiles of pH and the inorganic phosphorus (Pi) index were calculated from the spectra. A Pi-index recovery rate constant was calculated for each subject. Arteriograms were graded by calculating the runoff resistance in the limb of interest. The pH profiles during exercise did not differ significantly between the PAOD patients and control subjects. The Pi-index recovery rate constant in the PAOD patients was significantly (P less than .01) smaller than in the control subjects. There was no significant correlation between recovery rate and the ankle-brachial pressure indexes, but there was a strong negative correlation between recovery rates and angiographic resistance grades, with smaller recovery rate constants in patients with increased arterial resistance. It is concluded that P-31 MR spectroscopy shows promise as a direct measure of tissue perfusion.

Simplified peripheral arteriography

Demonstration of both iliofemoral arteries and their peripheral run-off is usually performed either by the translumbar approach, or by placing a pigtail catheter at the aortic bifurcation. A modified version of the old retrograde pressure method, simply using a cannula in one femoral artery, is described. There was considerable saving in materials, personnel and time. This method may once again be the method of choice in a busy radiology department.

The effects of prostaglandin E1 on peripheral arteriography

The effects of prostaglandin E1 on peripheral arteriography

Open Discussion: Peripheral Arteriography

Open Discussion: Peripheral Arteriography

Comparison of the Nonionic Contrast Agent Iopamidol and an Ionic Contrast Agent in Aortofemoral and Peripheral Arteriography

Comparison of the Nonionic Contrast Agent Iopamidol and an Ionic Contrast Agent in Aortofemoral and Peripheral Arteriography

Evaluation of Iopamidol in Peripheral Arteriography and Coronary Arteriography with Left Ventriculography

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Peripheral arterial disease diagnosed with high-count-rate radionuclide arteriography.

Thirty-seven patients with peripheral vascular disease involving the legs were studied with first-pass peripheral radionuclide arteriography (RNA) and contrast arteriography to determine whether RNA could be used to evaluate perfusion of the toes. Data were acquired for 100 seconds using a multicrystal gamma camera following bolus injection of 30-35 mCi (1,110-1,295 MBq) of Tc-99m-labeled albumin during reactive hyperemia. Peripheral time-activity curves were examined and the time required for activity to decline to 75% of peak activity ( T75 ) was recorded. When an abnormal RNA was defined as T75 greater than or equal to 50 seconds, sensitivity was 92%, positive predictive accuracy 100%, and negative predictive accuracy 75%. These data suggest that peripheral RNA of the toes is a reliable, noninvasive procedure for evaluation of peripheral arterial disease; it can be valuable as a screening test prior to contrast arteriography as well as for follow-up.

Optimal use of tolazoline in arteriography.

Intraarterial tolazoline, injected before the contrast medium in peripheral and visceral arteriography, has been shown to enhance the diagnostic value of the examination by inducing vasodilation. The time of maximal dilatation after injection, however, has not been clearly established. Photophlethysmography (PPG) was used to measure blood flow changes in 20 consecutive patients with lower-extremity arterial disease at rest and during the first 10 min after intraarterial tolazoline injection. Neither time to maximal dilatation (mean, 5.9 +/- 2.1 min) or PPG amplitude increase (mean, 251 +/- 177.2%) was significantly affected by the level of disease, severity of disease, or number of vessels present at the ankle. To make optimal use of tolazoline's vasodilatory effect, a waiting period of 6 min is recommended between tolazoline administration and contrast-medium injection in peripheral arteriography.

Superficial femoral artery occlusion: observations that influence patient selection criteria for angioplasty.

The length of an arterial occlusion is one criterion for selection of patients for transluminal angioplasty. A technique is described to fully evaluate the length of a superficial femoral artery occlusion during diagnostic peripheral arteriography.

A comparison of hexabrix and Renografin 60 in peripheral arteriography

Fifty-one patients were analyzed after a randomized double-blind study comparing Hexabrix and Renografin 60 in peripheral arteriography. The arteriographic studies and the volumes of contrast material used in both groups were similar. Hexabrix caused significantly less pain and discomfort than Renografin 60, and the diagnostic quality of the radiographs was comparable. A slightly higher incidence of minor side effects was noted in the Hexabrix group, mostly nausea and vomiting and urinary retention.

Study of safety and tolerance of iopamidol in peripheral arteriography.

Iopamidol, a non-ionic contrast agent, was evaluated during peripheral arteriography in 10 patients. All reported a sensation of warmth during injection. One described the procedure as moderately painful. All objectively tolerated the injections well, and there were no significant changes in clinical or laboratory findings. Vessel opacification was good to excellent in all cases. The authors suggest that non-ionic contrast agents replace ionic agents for peripheral arteriography.

Iopamidol: a non-ionic contrast agent for peripheral arteriography.

Ten patients undergoing peripheral arteriography with iopamidol were evaluated in a carefully controlled Phase I study using a variety of objective and subjective tests of discomfort. There was minimal objective evidence of pain, and the patients reported that they perceived minor discomfort and a warm sensation during the contrast injections. Five patients who had previously undergone arteriography using 2 mg of lidocaine per ml of methylglucamine diatrizoate noted a marked decrease in discomfort when iopamidol was used. Opacification of peripheral arteries was excellent. Multiple physical examinations, chemical tests, electrocardiograms, and intra-arterial pressure recordings showed that iopamidol is safe.

Intravenous Arteriography Using Digital Subtraction Techniques

The application of digital computers to electronic x-ray imaging devices has rejuvenated interest in the field of intravenous arteriography. By utilizing computer image subtraction techniques, digital roentgenographic systems based on fluoroscopy or computed tomography (scanned projection radiography) provide significantly improved vascular imaging compared with conventional film subtraction methods. Digital subtraction angiography schemes isolate contrast media in the vessel by detecting differences in images obtained before and after the injection of contrast medium or changes in the relative attenuation of contrast media at different x-ray energies. Present applications include carotid and peripheral arteriography, thoracic and abdominal aortography, pulmonary arteriography, and ventriculography. Future applications may include intracerebral and coronary arteriography. These systems should provide low-risk outpatient screening arteriography.

Improved arterial portography in portal hypertension during reactive mesenteric hyperemia induced by preceding 2-minute balloon occlusion of the superior mesenteric artery.

The value of performing arterial portography during reactive hyperemia was investigated in four dogs with presinusoidal cirrhosis, stable portal hypertension in excess of 20 cm of water, and extensive porto-systemic venous collaterals, and compared to tolazoline (1 mg/kg) and control studies. With SMA balloon occlusion the maximum decrease in portal flow and pressure occurred between 1 and 2 minutes. During reactive hyperemia following immediately the release of a 2-minute SMA occlusion, portal flow and pressure increased from pre-occlusion values (mean +/- 1 SE, n:4) of 15 +/- 2 ml per min per kg and 25 +/- 1 cm H2O to 32 +/- 5 ml per kg and 40 +/- 2 cm H2O. With reactive hyperemia both significant higher peak iodine concentrations in the portal blood and significant improvement in visualization of the portal system and porto-systemic venous collaterals occurred when compared to tolazoline or control angiograms. With reactive hyperemia both peak blood iodine concentrations and maximum opacification of the portal vein occur 2 to 3 and 4 to 6 seconds earlier than with tolazoline or in controls, respectively. Compared to controls, tolazoline increased peak iodine concentrations in portal vein significantly and improved visualization of the portal system and collaterals in 7 of 12 examinations. Judged from the experience in peripheral arteriography, performance of angiography during reactive hyperemia appears to be a very safe procedure. However, the use of balloon catheters carries additional risks particularly when not properly used.

Epidural anesthesia: effective analgesia in aortoiliofemoral arteriography.

The efficacy of epidural anesthesia for control of pain experienced by patients undergoing peripheral arteriography was studied in 77 patients. In 70 patients, arteriographic studies were completely painless. Two patients experienced severe pain, while five felt different degrees of limited pain and/or burning sensation. Arteriograms in the 77 patients were excellent because the analgesia allowed injection of large volumes of contrast, the patients did not move during the injection because of motor block, and finally the sympathetic block probably resulted in peripheral vasodilatation. We believe that epidural anesthesia represents the method of choice in the control of pain during arteriographic examinations of the lower extremities.

Pain in peripheral arteriography—a comparison of a low osmolality contrast medium with a conventional compound

The pain reaction to a new low osmolality contrast agent, sodium-methyl-glucamine-ioxaglate, in comparison to the conventional compound methylglucamine-ioxitalamate was tested and statistically evaluated in 12 patients using the visual analogue scale method. The intensity of pain experienced was significantly smaller following intra-arterial injection of the compound of low osmolality as compared to the conventional contrast agent.

Arteriography in thromboangiitis obliterans

Thromboangiitis obliterans is now concepted as a clinical entity with unknown etiology and pathogenesis, occurring in young adult male smoker. Peripheral arteriography is important for decision of biopsy site and vascular bypass graft whom thromboangiitis obliterans is suspected. At Department Of Radiology, Seoul National University Hospital, 53 patients of thromboangiitis obliterans, were studied with peripheral arteriography during August 1971 to January 1979. The arteriography findings are acute and segmental occlusion and diffuse narrowing. The most frequent occlusion sites are anterior tibial artery and posterior tibial artery, and 23 patients the occlusion was above popliteal artery. Proximal cork-screw type collaterals are developed in large arterial occlusion and distal tree-root appearance in small arterial occlusion below popliteal artery. Standing waves are seen in 17 arteries of 12 patients, and most frequent (7 arteries) in superficial femoral arteries.

The Use of Intra-arterial Lidocaine to Control Pain Due to Aortofemoral Arteriography

Intra-arterial lidocaine has been utilized to decrease pain by administration prior to contrast material injections during aortofemoral arteriography in over 600 patients. Because this observation was uncontrolled, a double-blind study was performed in 15 patients comparing the effectiveness of intra-arterial lidocaine and saline in the control of pain from contrast material injections (methylglucamine iothalamate) in pelvic and peripheral arteriography. Two per cent lidocaine was compared with 1% lidocaine in the same manner in an additional 10 patients. Peripheral vein blood samples were obtained in 4 patients to measure the plasma concentration of lidocaine. Intra-arterial lidocaine is safe and effective in reducing pain from intra-arterial contrast agent injections.

Intraarterial analgesia in peripheral arteriography

A pilot study involving 36 patients was undertaken to test the efficacy of combining 1% lidocaine with 60% methylglucamine iothalamate for relief of the severe burning pain often experienced during peripheral arteriography. Of 24 patients premedicated with meperidine hydrochloride and promethazine hydrochloride, 12 received lidocaine with the contrast medium and 12 did not. The remaining 12 patients were premedicated with diazepam and received lidocaine with the contrast material. By both subjective and objective criteria, those patients receiving lidocaine in the intraarterial injection of contrast medium suffered less pain. Optimum results were achieved for the lidocaine group receiving analgesic premedication. No adverse reactions attributable to the lidocaine were encountered. Subsequent to completion of the pilot study, more than 300 patients have been studied with similar impressive results of pain relief and safety.