Techniques for lower-limb angiography: a comparative study.
Three separate variables--volume of contrast material, site of contrast material injection, and arterial inflow occlusion--were tested in a prospective, randomized fashion in 52 patients to determine the best technique for lower-limb angiography. Twelve patients received 30 and 60 mL of contrast material injected at the level of the external iliac artery (EIA), 20 patients received 60 mL injected at the level of the EIA with and without inflow occlusion, and 20 patients received 120 mL injected at the level of the aortic bifurcation and 60 mL injected at the level of the EIA. A total of 104 angiograms were obtained, two in each patient. Two examiners reviewed all angiograms in a blinded fashion, initially as 104 separate studies for diagnostic adequacy (ie, the need for additional angiography) and then as 52 paired studies for direct comparison of the quality of arterial filling (ie, the best-appearing angiogram). The 60-mL studies were significantly better (P less than .001) in both categories when compared with both the 30- and the 120-mL studies. There was, however, no significant difference between the 60-mL studies with and without inflow occlusion. The authors conclude that the best screen-film lower-limb angiograms are obtained with large volumes (60 mL) of contrast material injected below the pelvic vessels (EIA).
Smith, TP; Cragg, AH; Berbaum, KS; Ryals, TJ; Sato, Y
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