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Intravenous digital subtraction angiography: its use in evaluating vascular injuries in children
P M Parker1, C D Vinocur, E Smergel
1Department of Surgery and Radiology, St Christopher's Hospital for Children, Temple University School of Medicine, Philadelphia, PA 19133.
Insights
Intravenous digital subtraction angiography (IV-DSA) offers a less invasive way to evaluate vascular injuries in children, reducing risks associated with arterial cannulation. This method effectively diagnoses various vascular conditions, potentially replacing conventional arteriography in pediatric cases.
Area of Science:
- Pediatric radiology
- Vascular imaging
- Diagnostic angiography
Background:
- Arterial cannulation for angiography carries significant risks in children.
- A less invasive diagnostic method is needed for pediatric vascular injury evaluation.
- Intravenous digital subtraction angiography (IV-DSA) presents a potential alternative.
Observation:
- Nine children (9 months to 16 years) with suspected vascular injuries underwent IV-DSA.
- IV-DSA identified false aneurysms, arteriovenous fistulas, and iliac occlusion.
- Normal vascular findings on IV-DSA avoided unnecessary surgical exploration in four children.
Findings:
- IV-DSA accurately diagnosed vascular injuries, including false aneurysms and arteriovenous fistulas, guiding appropriate management.
- The procedure successfully identified an iliac occlusion, which was managed non-surgically.
- In four cases, IV-DSA confirmed normal vasculature, preventing invasive procedures.
- A planned skin flap was avoided in an electrical injury case due to IV-DSA findings.
Implications:
- IV-DSA effectively obviates the need for intraarterial angiography in pediatric vascular injury assessment.
- This technique requires less radiation and time compared to conventional arteriography.
- IV-DSA can serve as a definitive diagnostic tool in pediatric vascular imaging, though intraarterial angiography may be needed selectively.
Abstract:
Angiography is often essential in the evaluation of patients with suspected vascular injuries. However, arterial cannulation has a significant inherent complication rate, especially in small patients. Therefore, a less invasive method of evaluating children with such injuries is desirable. We report nine children (age range, 9 months to 16 years; median, 7 years) in whom intravenous digital subtraction angiography (IV-DSA) was used to evaluate suspected vascular injuries. IV-DSA showed a false aneurysm in two children, one managed by ligation alone and the other by resection with primary anastomosis. One child was found to have an arteriovenous fistula, which was treated by ligation. An iliac occlusion, following an arteriogram to evaluate a liver tumor, was documented by IV-DSA and successfully managed with aggressive anticoagulant therapy. Demonstration of a normal vascular tree avoided exploration in four children. A planned skin flap was abandoned in a child who suffered an electrical injury when IV-DSA showed lack of adequate vascular supply. In all nine cases, the IV-DSA obviated the need for intraarterial angiography. In addition to avoiding arterial cannulation, IV-DSA required significantly less radiation and less time to perform than conventional arteriography. Motion artifact, vessel overlap, and some loss of minute detail are some of its potential shortcomings. IV-DSA is an effective method of screening children with suspected vascular injuries. In addition, our experience has shown that IV-DSA can be the definitive diagnostic procedure, although intraarterial angiography may be necessary in selected cases.