Retrograde Arteriography Research Articles

Radial Artery Anomalies and Subsequent Impact on Transradial Coronary Procedures—A Single Centre Experience

Background: Wollongong Hospital is a regional tertiary referral centre in NSW. A transradial approach for coronary angiography and intervention was commenced in March 2010. The transradial approach has a number of significant advantages over the femoral approach; however various technical challenges have impeded its utilisation. Some of these challenges relate to radial artery anatomy. Our aim is evaluate the incidence and influence of radial artery anomalies with regards to transradial procedures. Methods: Data related to baseline characteristics, procedure variables, radial artery anatomy and procedure outcome were collected on patients due to have retrograde radial arteriography performed between June 2011 and March 2012. Results: 135 patients were included in this study. Mean age was 67.05 years, M:F (75:60). In total 128 patients underwent retrograde arteriography (seven arteries unable to be viewed). The incidence of radial artery anomaly was 13/128 (10%). Anomalies identified were tortuous arteries (n = 5, 4%), loops (n = 4, 3%) and high bifurcations (n = 4, 3%). Overall success was 121/135 (89.6%). The success rate in patients with normal radial anatomy was 110/115 (95.6%) and in those with anomalies 11/13 (84.6%). The breakdown of success rate was 80% (4/5) in tortuous arteries and 75% (3/4) in both high bifurcations and loops. Of note the failure in the high bifurcation artery was due to spasm. Conclusion: Our study shows that radial artery anomalies are relatively common and the success rate of coronary procedures is also lower in these patients. The use of retrograde radial angiography can help operators evaluate radial artery anatomy and devise strategies to improve success rate.

Computerized tomography in the investigation of groin masses following femoral catheterization.

Pseudoaneurysm of the femoral artery is an uncommon complication of retrograde arteriography. It is sometimes difficult to clinically differentiate a pseudoaneurysm from a large hematoma. We present 13 cases of suspected femoral pseudoaneurysm following angiography which were investigated by computed tomography (CT). It is suggested that this is a useful procedure in the investigation of groin masses after catheterization.

Lung sequestration: report of seven cases and review of 540 published cases

We present an analysis of 400 intralobar and 133 extralobar sequestrations, six cases presenting intra- and extralobar sequestration simultaneously, five sequestrations of one whole lung, and two bilateral intralobar sequestrations. This anomaly comprises 0·15-6·4% of all congenital pulmonary malformations. Usually the posterior basal segment is affected. The aberrant artery in intralobar sequestration originated in 74% of all cases from the thoracic aorta, and in 14·8% there was more than one anomalous artery. The mean diameter of the aberrant arteries was 6·3-6·6 mm. Usually arteries with predominantly elastic fibres were found. Arteriosclerotic changes were common, even in children. The venous return of the intralobar sequestration is, in 95·7% of all cases, via the pulmonary veins. In 13·7% of all cases other congenital malformations were observed. Symptoms arose within the first decade of life in 37·2% Bronchography and retrograde arteriography are the mainstay of diagnosis. Sequestrations are not supplied by a bronchial artery. Treatment of choice is operation as early as possible. Altogether seven operative deaths were reported, five of which were due to haemorrhage during operation. Of the 133 extralobar sequestrations, 77·4% were located between diaphragm and lower lobe. The arterial supply was provided by branches of the aorta. Some cases were supplied with venous blood by branches of the pulmonary artery. In six cases secondary changes, such as tuberculosis or carcinoma were found. In 60% of all the patients symptoms occurred within the first decade of life. Preoperative diagnosis was correct in only six cases. There were four postoperative deaths.

Phalloarteriography in the diagnosis of erectile impotence.

AbstractAn angiographic method has been developed for x‐ray visualization of the arteries supplying the cavernous bodies of the penis, namely, the internal iliac, internal pudendal, and penile artery and its branches (dorsal, deep, and bulbocavernous arteries). Under normal conditions the technique makes pulsations in both dorsal penile arteries palpable, and the flow rate of fluid into the cavernous bodies necessary to produce and maintain erection can be determined. The principle of the method involves artificial passive erection or semierection, during which we perform selective or semiselective arteriography of the bed supplied by the internal iliac artery, or retrograde arteriography by puncture of the dorsal artery of the penis.Thirty males complaining of more than 1 year of impotence (including 12 diabetics) were investigated, 29 by our standard technique and 1 by translumbar pelvic arteriography with retrograde arteriography of the dorsal penile artery. All patients showed severe stenosis or obliteration of the vessels supplying the cavernous bodies. There was agreement between absence of pulsation in the dorsal penile arteries and the angiographic findings. Flow rates necessary to produce erection varied from 45 to 160 ml/min, with a mean of 90 ml/min. For controls, angiographic studies were performed in 4 men with clearly psychogenic impotence, all of whom were found to have normal‐appearing arteries supplying the cavernous bodies.On the basis of these findings and previously reported histological investigations, we believe that most impotence is the symptomatic and functional result of arterial disease. The arteriographic technique described allows a precise anatomical diagnosis to be made, and can indicate surgical and microsurgical correction.

Celiac angiography in the management of splenic trauma.

The diagnosis of splenic rupture following trauma is often obvious, but it may present a perplexing problem. In most instances the correct diagnosis can be made from the history of the injury, the physical examination, and a few simple diagnostic studies which are well known and accepted and need not be discussed in detail here.1,2These include radiographic evidence of splenic enlargement and/or gastric or colonic displacement on a plain film of the abdomen. However, such radiologic findings are indirect and inconsistent, and only rarely do they visualize the spleen with certainty. Although one of our patients dates back to 1954, Norell in 1957 was the first to report retrograde arteriography performed for the diagnosis of splenic trauma.3Scattered case reports and small series of cases utilizing this approach have appeared in the literature since then.4-10The largest group of which we are aware is that of

The use of pulse monitor in retrograde arteriography.

The use of pulse monitor in retrograde arteriography.

Prevention and treatment of complications following arteriography.

For the past decade, vascular roentgenology has been the fastest-expanding subspecialty of diagnostic radiology. Because of its definition and the need for the information it furnishes in the growing field of vascular surgery, a further and even more rapid expansion is anticipated. Like any other operative procedure, arteriography can cause certain complications, and the endorsement of a diagnostic procedure for widespread use can be given only after its benefits, in particular the information derived from it, are weighed against its risks of complications (1, 5, 6, 12, 14, 15, 17, 20, 21). In 1962 a nationwide survey with tabulation of the complications of percutaneous retrograde arteriography established a then-acceptable rate of complications attributed to this procedure (17). A critical analysis of these data focused our attention on certain obvious causes of complications, which have since been corrected and eliminated. By definition, all complications occurring within forty-eight hours of a vascular opacification study are counted as secondary to the procedure. Baum et al. (3) and Abrams (1) pointed out the difficulty in analyzing the relationship of the patient's preangiographic condition to any possible postangiographic complication. In an analysis of 1,600 consecutive vascular catheterization studies, Baum noted a striking similarity in the incidence and character of reactions occurring within the forty-eight hours prior to angiography, if the studies were delayed, and those in the forty-eight hours after the procedure, if the studies were performed promptly after scheduling. This careful statistical study suggests that many complications incorrectly attributed to angiography are in fact caused by the primary disease. The purpose of this paper is to establish the efficacy of “intensive postoperative care” and changes in “procedure” which are based on the recommendations of an analysis of our nationwide survey in preventing or at least substantially decreasing complications secondary to a catheterization procedure. Analysis of Factors Predisposing to the Development of Complications A critical analysis of our nationwide survey of 1962 readily established several prominent causes predisposing to complications (17). Minor complications, defined as conditions resulting in only transient discomfort, appeared to be most commonly related to faulty technic, unnecessarily large and ridged catheterization equipment, traumatic introduction and advancement of guide wires and catheters, excessively long catheterization procedures, and inadequate manual compression at the puncture site. The coexistence of multiple minor complications appeared to potentiate the ill effects and frequently resulted in serious complications. Pre-existing poor vascular fitness, in particular, intensified the ill effects of any minor complication.

PATHOPHYSIOLOGY OF SUBINTIMAL HEMATOMA FORMATION DURING RETROGRADE ARTERIOGRAPHY.

Major complications of clinical retrograde arteriography arouse continuing concern (1–7). A toxic effect of the contrast medium has been implicated in the production of certain types of lesions (11), but in a substantial group of patients, technical or mechanical factors appear to be major determinants of ensuing disability. Gudbjerg and Christensen (6) found a remarkable incidence of aortic dissection following retrograde aortography in the investigation of arteriosclerotic disease in their series: 36 instances of aortic dissection in 126 patients. Because of these findings, some radiologists (1) have virtually abandoned retrograde aortic catheterization in arteriosclerotic patients, employing instead the direct translumbar approach for the investigation of atherosclerosis of the great vessels. Some years ago, Gaylis and Laws (4) pointed out that many of the common serious neurological, renal, and gastrointestinal complications following aortography are strikingly similar to those associated with spontan...

A Survey of the Complications of Percutaneous Retrograde Arteriography

The abundance of publications on the various applications of retrograde percutaneous arteriography in the recent literature reflects the great interest in this method. Sporadic references to complications have appeared in several papers (1, 2, 5, 9, 11, 17, 22, 23, 25, 26, 35, 36, 39, 41–43, 45, 48, 51, 55, 58, 59, 61–64). Abrams in 1957 reported a mortality rate of 1.7 per cent in thoracic aortography (2). A survey of the complications of translumbar aortography by McAfee revealed a mortality rate of 0.28 per cent and an incidence of serious nonfatal complications of 0.74 per cent (53). The present paper attempts to arrive at a comparable estimate of the dangers of percutaneous retrograde arteriography. A questionnaire was sent to 300 hospital radiologists, urologists, and vascular surgeons in the United States in April 1962. Two hundred and four replies were received of which 142 were adequate for statistical analysis. The returns were carefully scrutinized for completeness of data to provide a reference source from which information might be derived for balancing the risk of the procedure against the diagnostic information disclosed. Seven fatal and 81 serious complications were recorded in 11,402 tabulated procedures, representing a mortality rate of 0.06 per cent and a serious complication rate of 0.7 per cent. The complication was termed serious if increased morbidity or major late sequelae could be causatively related to the examination. A minor complication was defined as a condition resulting only in transient discomfort. The minor complication rate was relatively high (approximately 3 per cent). Minor Complications The minor complications of retrograde percutaneous arteriography are, in order of frequency, temporary arterial spasm, asymptomatic local hematomas, asymptomatic intramural or subintimal injections, and perforation of major vessels without late sequelae. Multiple traumatic punctures, poor local anesthesia, traumatic advancement of the guide wire or catheter, and excessively long catheterization procedures appeared to be the most common causes for temporary arterial spasm. Inadequate manual compression at the puncture site or improper application of pressure dressings seemed to predispose to the formation of local hematomas. The experience of the operator and the precision of the technic were apparently the most significant factors influencing the incidence of minor complications. Diabetic patients and patients with arteriosclerotic disease in the advanced age group were particularly prone to such complications. The latter group appeared to sustain many intramural injections or perforations of their tortuous vessels. Brachial artery catheterization showed a significantly higher rate of complications than femoral catheterization.

Surgical Management of Cavernous Hemangioma of the Chest Wall

A case report of an 18-year-old girl with a cavernous hemangioma of the chest wall is presented. Preoperatively, hematologic study revealed thrombocytopenia, hypoprothrombinemia, defective clot retraction, and increased bleeding time. Retrograde arteriography revealed that the vascular supply of the lesion originated from the left fifth to the tenth intercostal artery. It was felt that the symptoms and findings were similar to those described for the Kasabach-Merritt syndrome. The lesion and the chest wall were successfully resected en bloc. Six days postoperatively the preoperative hematologic defects had all returned to normal levels. A discussion of the Kasabach-Merritt syndrome and of the relationship of the coagulation defects to the lesion are presented.

Retrograde arteriography in the staging an follow-up of bladder tumors.

Recent literature shows a significant upsurge of interest in arteriographic demonstration of bladder tumors (4, 5, 9, 10). This method supplies the long needed adjuncts for the proper staging of these tumors and for serial follow-up examinations of patients receiving radiotherapy. Jewett's theory of a correlation between the depth of infiltration of bladder tumors and their curability is now a well accepted fact (6–8). Hence, preoperative staging has become the determining factor for the mode of treatment (8, 12, 13). Until recently, staging of tumors of the bladder has been based largely on palpation under anesthesia, cystoscopy, and selective biopsy through the resectoscope (6–8, 12, 13). Radiographic examination following perivesical air insufflation, plexus angiography, and double-contrast cystography have been of secondary importance and have failed to supply substantial additional information (1–3). Selective arteriography of the hypogastric arteries, however, readily demonstrates the lesion. A characteristic staining quality of the tumor in the capillary phase and the classical appearance of the tumor vessels offered the first specific visualization of bladder tumors in all positions. Neoplastic and inflammatory masses could be readily differentiated; particularly, tumors in the anterolateral position that are habitually difficult to evaluate by bimanual examination could now be easily demonstrated and staged (9, 10). A modified Seldinger technic has been advocated for the demonstration of these bladder tumors (9, 10, 14). In addition, carbon dioxide or nitrous oxide insufflation is used as an intravesical medium. Retrograde arteriography has been employed in the diagnosis and preoperative staging of bladder tumors and for the follow-up examination of those patients subjected to radiation therapy. The observations were confirmed by histologic examination of the specimen or suprapubic cystotomy in 14 cases. In the remainder, serial biopsy through the resectoscope and typical findings on bimanual examination under anesthesia were felt to suffice as clinical proof for the arteriographic staging. The arteriographic diagnosis of bladder tumors relies on the demonstration, in the arterial phase, of increased size of the vesical arteries supplying the tumor-bearing area and massive vessels in the pedicle of the tumor. The late arterial phase may show the characteristic corkscrew vessels reminiscent of the tumor vessels of a meningioma. These vessels are usually seen within one and one-half to three seconds after the beginning of the injection. There is probably a correlation between the capillary stain of the tumor and its histologic grade. In poorly differentiated tumors, a very early and dense capillary stain was encountered. The draining veins from these tumors appeared to fill earlier than those from more differentiated neoplasms. This is apparently related to the presence or absence of arteriovenous shunts in the tumors.

Percutaneous transfemoral renal arteriography in hypertension.

Renal Arteriography finds its most important application in the study of renal hypertension. The modified Seldinger technic (1) of percutaneous transfemoral retrograde arteriography provides a precise and accurate demonstration of the anatomy and vascular pathology of the renal arteries and their intrarenal branches. In addition, a nephrography phase during the study reflects the status of the renal parenchyma. The radiologic demonstration of the anatomic-pathologic state of the renal vessels is mandatory for the surgical approach to remediable lesions. A recent study (2) in which aortography was used extensively in hypertensive patients demonstrated lesions of occlusive renal arterial disease in about 25 per cent of the total. The occlusive lesion was considered to be the primary cause of the hypertension in the majority. Occlusive renal arterial disease is listed as the most common cause of hypertension which is amenable to surgical correction, and at this time, 75 (3) to 82 per cent (4) of patients have been made normotensive following appropriate surgery. Material and Methods The clinical material forming the basis for this report comprises the first 41 cases studied following the adoption of the percutaneous transfemoral technic of Seldinger by the Department of Radiology at The New York Hospital-Cornell Medical Center. In 4 cases the catheter was passed through a femoral arteriotomy that was deemed clinically advisable. Completely adequate pre-examination medication for the percutaneous method has consisted in the administration of 50 to 100 mg. of soluble phenobarbital intramuscularly. Thirty-seven of 38 patients underwent examination by an attending radiologist with passage of the transfemoral catheter under local procaine anesthesia. In one instance, a tense, nervous seventeen-year-old boy was studied under general anesthesia. Precautionary post-examination steps have consisted of inguinal pressure dressings and bed rest for approximately six hours. There have been no complications except for two minimal subcutaneous hematomas. Pre-arranged catheter lengths have made fluoroscopy unnecessary. The detailed anatomic study of angionephrography by Edsman (5) has made this pre-arrangement possible. A test film has been utilized to check and correct the position of the tip of the catheter before injection of the contrast medium and the start of the serial filming procedure. In a few instances the guide wire or catheter was inadvertently passed into the deep circumflex iliac artery or the common iliac oi the contralateral side. In these cases the catheter was easily readjusted or passage was made through the opposite femoral artery. The hand-operated Lehman and mechanical Cordis or Gidlund injectors have been used to instill the organic iodide contrast agent. The mechanical pressure injectors are superior, since they allow a more delicate pressure control and a greater flow rate of the opaque medium in terms of cubic centimeters per second.

Coarctation of the aorta in children: Observations in fourteen cases

Summary Our experience in fourteen cases of coarctation of the aorta has been presented. Twelve of these cases have had some type of surgical correction. An analysis of our material places our patients into two clinical groups. The importance of coarctation of the aorta as a cause of cardiac decompensation in children under 5 years of age is demonstrated in our Group I. Group II demonstrates the early appearance of the degenerative effects of continued hypertension. The values of retrograde arteriography have been outlined, the methods of surgical repair reviewed, and the results detailed. Our concepts of the indications for surgical treatment of coarctation of the aorta in children are presented.

Retrograde arteriography in the diagnosis of cardiovascular lesions; coarctation of the aorta.

Article1 May 1950RETROGRADE ARTERIOGRAPHY IN THE DIAGNOSIS OF CARDIOVASCULAR LESIONS. II. COARCTATION OF THE AORTANORMAN E. FREEMAN, M.D., EARL R. MILLER, M.D., H. BRODIE STEPHENS, M.D., MARY B. OLNEY, M.D.NORMAN E. FREEMAN, M.D.Search for more papers by this author, EARL R. MILLER, M.D.Search for more papers by this author, H. BRODIE STEPHENS, M.D.Search for more papers by this author, MARY B. OLNEY, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-32-5-827 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn a previous communication1 the usefulness of retrograde arteriography in the diagnosis of aneurysms and peripheral vascular lesions was discussed. The present paper is concerned with the visualization of the thoracic aorta and its branches by means of radiopaque material injected into the common carotid artery in a retrograde fashion. This technic has been of use in the diagnosis and localization of coarctation of the aorta.At the time that Farinas2demonstrated his studies on retrograde arteriography for visualization of the abdominal aorta at the radiological meetings in Chicago in 1944, it occurred to one of us (E. R. M.)...Bibliography1. FreemanMiller NEER: Retrograde arteriography in the diagnosis of cardiovascular lesions. I. Visualization of aneurysms and peripheral arteries, Ann. Int. Med. 30: 330-342, 1949. LinkGoogle Scholar2. Farinas PL: Retrograde abdominal aortography, Am. J. Roentgenol. 55: 448, 1946. Google Scholar3. RobbSteinberg GPI: Visualization of the chambers of the heart, the pulmonary circulation and the great blood vessels in man: summary of method and results, J. A. M. A. 114: 474, 1940. Google Scholar4. GrishmanSteinbergSussman AMFML: Contrast roentgen visualization of coarctation of the aorta, Am. Heart J. 21: 305, 1941. CrossrefGoogle Scholar5. Steele JM: Evidence for general distribution of peripheral resistance in coarctation of the aorta: report of three cases, J. Clin. Investigation 20: 473, 1941. CrossrefMedlineGoogle Scholar6. Blackford LM: Right aortic arch, Am. J. Dis. Child. 44: 823, 1932. CrossrefGoogle Scholar7. RailsbachDock OCW: Erosion of the ribs due to stenosis of the isthmus (coarctation) of the aorta, Radiology 12: 58, 1929. CrossrefGoogle Scholar8. Gladnikoff H: The roentgenological picture of the coarctation of the aorta and its anatomical basis, Acta Radiol. (Stock.) 27: 8, 1946. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: San Francisco, California*Received for publication March 5, 1949.From the Divisions of Surgery, Radiology, and Pediatrics, University of California School of Medicine, San Francisco 22, California. Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDarstellung der Herzhöhlen, der Gefäßlumina und des BlutstromesArteriography of Peripheral VesselsCOARCTATION OF THE ABDOMINAL AORTADie Coarctatio aortae abdominalisCoarctation of the abdominal aorta with stenosis of the renal arteries and hypertensionMultiple and Infraductal Coarctations of the AortaCoarctation of the abdominal aortaElectrocardiogram of Early and Mild Coronary OcclusionCOARCTATION OF THE ABDOMINAL AORTA WITH DEATH FROM RUPTURE OF AN ANEURYSM OF A CEREBRAL ARTERY*S. FRED KAUFMAN, M.D., JAMES W. MARKHAM, M.D.RESECTION OF THE THORACIC AORTA WITH REPLACEMENT BY HOMOGRAFT FOR ANEURYSMS AND CONSTRICTIVE LESIONSRESECTION OF AN ACQUIRED COARCTATION OF THE LOW THORACIC AORTA AND REPLACEMENT WITH A PRESERVED VESSEL GRAFTCoarctation of the AortaAngiocardiography in congenital heart diseaseCOARCTATION OF THE AORTA AT THE LEVEL OF THE DIAPHRAGM TREATED SUCCESSFULLY WITH A PRESERVED HUMAN BLOOD VESSEL GRAFT 1 May 1950Volume 32, Issue 5Page: 827-841KeywordsAneurysmsAngiographyAortaCommon carotid arteriesDiagnostic radiologyLesionsPediatric surgeryPediatrics ePublished: 1 December 2008 Issue Published: 1 May 1950 Copyright & PermissionsCopyright, 1950, by The American College of PhysiciansPDF downloadLoading ...

Retrograde aortography; its value in the diagnosis of coarctation of the aorta by means of a new indirect sign.

The history of retrograde arteriography and aortography dates back to 1937, when one of the present authors (Pereiras) was able to delineate the subclavian artery in the living subject by injection of a contrast substance into the axillary artery. The case was reported the following year (2), demonstrating that the radiopaque medium could be introduced counter to the direction of the blood stream providing it were injected under sufficient pressure. In 1937, also,retrograde arteriography was performed by us on various occasions on the cadaver (1) with the object of obtaining angiocardiograms upon which an anatomic diagnosis of congenital heart disease might be based in cases in which autopsy was not available (Fig. 1). In the same year, while attempting angiocardiography in a child, we mistook the femoral artery for the femoral vein, with the result that we obtained not an angiocardiogram but a retrograde arteriogram of the external iliac, common iliac, abdominal aorta, and part of the thoracic aorta. In ...

On the Technique of High Retrograde Arteriography in Circulatory Disturbances of the Lower Limbs

On the Technique of High Retrograde Arteriography in Circulatory Disturbances of the Lower Limbs

On the Technique of High Retrograde Arteriography in Circulatory Disturbances of the Lower Limbs

On the Technique of High Retrograde Arteriography in Circulatory Disturbances of the Lower Limbs