Invasive imaging of abdominal aortic occlusions: intravenous versus intra-arterial route

We studied 16 patients of abdominal aortic occlusion by digital subtraction angiography (DSA) in order to assess the advantages and limitations of Intravenous (IV) and Intra-arterial (IA) imaging in this rare clinical setting. All the patients had systemic hypertension and 14 patients (87.5%) also had associated coronary artery disease. Ten patients underwent IV-DSA and all were diagnostic. Eight of them had "stable" angina and, of these three patients (37.5%) developed clinical features of angina pectoris 5 to 10 minutes after the study. The remaining 6 patients who had "unstable" angina underwent an uneventful IA-DSA by transbrachial route. Intravenous DSA should be performed with caution since both the central venous contrast injection and Buscopan injection, used to control intestinal peristalsis, result in a transient increase in the cardiac workload, increase the myocardial oxygen demand and can precipitate myocardial ischaemia in the "high-risk" coronary patients. These patients should be electively studied by IA-DSA by transbrachial route inspite of the fact that IV-DSA examinations, if done, are usually diagnostic.