Comparison of brachiocephalic angiography and IVDSA in the same group of patients

In this investigation for the first time conventional angiography (CA) and intravenous digital subtraction angiography (IVDSA) of the aortic arch and brachiocephalic vascular territory is compared in the same group of 25 patients. The quality of the image derived from IVDSA is inferior to that of CA and, moreover, varies with the location. If sufficiently good, IVDSA has an accuracy of 81 to 91% in comparison to CA for stenotic lesions depending on the site. Ulcerations are missed more frequently than with CA. Discrepancies between IVDSA and CA are caused mainly by misregistration. According to our investigation there are multiple stenotic lesions in the brachiocephalic territory in 84% of the patients. Adequate assessment of the need for surgery in symptomatic patients can therefore only be made after complete visualization of the aortic and brachiocephalic vascular territory. If non-invasive methods, like duplex-scanning, cannot fulfill this requirement, IVDSA is the only semi-invasive method that can provide the information. It is therefore desirable to improve IVDSA technique in the near future instead changing to intra-arterial DSA (IADSA). Now already the advantages outweight the drawbacks.