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[Arteriography in old age--an assessment of the risks and technique (author's transl)]
Insights
Catheter angiography is feasible and safe in patients over 70 years old, even with severe vascular disease. A counter-current technique using the Hettler instrument offers advantages for older patients.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Geriatric Medicine
Background:
- Arteriography is a crucial diagnostic tool for evaluating vascular disease.
- Older patients (≥70 years) often present with complex vascular conditions, posing challenges for diagnostic procedures.
- Assessing the feasibility and safety of arteriography in this demographic is essential.
Purpose of the Study:
- To retrospectively analyze the indications, findings, and outcomes of arteriograms in patients aged 70 years or older.
- To evaluate the safety and efficacy of standard catheter angiography and alternative techniques in this patient group.
Main Methods:
- Retrospective review of 1,263 arteriograms performed over 2.5 years, focusing on 166 patients aged 70+.
- Analysis of indications, angiographic findings, procedural success rates, and complications.
- Evaluation of the Hettler counter-current technique for retrograde aortography when catheter angiography was not feasible.
Main Results:
- Arteriography was successfully performed in most elderly patients (159/166), with only 7 examinations being impossible due to advanced pelvic vascular disease.
- Minor complications occurred in 3 patients; one case of external iliac artery occlusion was managed surgically.
- Vascular calcification on plain films did not predict catheterization difficulties.
- The Hettler counter-current technique was successfully used, proving safe and advantageous for older patients.
Conclusions:
- Catheter angiography is a feasible and generally safe procedure in patients aged 70 years and older.
- The Hettler counter-current technique provides a valuable alternative for retrograde aortography in elderly patients when standard methods fail.
- Age alone should not be a contraindication for diagnostic arteriography.
Abstract:
Of 1,263 arteriograms performed over a period of two and a half years, there were 166 patients aged 70 years or more. The indications, angiographic findings and results have been examined retrospectively. In seven patients only was it impossible to carry out the examination because of advanced vascular disease in the pelvis. Most examinations could be performed as planned. In three patients there were minor complications without consequence. In one patient the external iliac artery was occluded following catheter angiography, but this was disobliterated during a subsequent operation which would have been carried out in case. The severity of vascular calcification as seen on plain films gives no indication regarding the difficulties during catheterisation. If aortography by catheter is impossible, we demonstrate the aorta retrogradely by a counter-current technique, using the Hettler instrument. The Hettler technique does not increase the risk and has certain advantages for the examination of older patients.