[Ascending venous angiopneumography. A new method of exploration in pulmonary embolism]

Selective angiopneumography is considered to be the best diagnostic investigation for pulmonary embolism. However, the technique has to be performed in a specialised unit, is associated with a certain degree of risk and does not explore the lower limb veins which are the usual site of migratory thrombi. The authors have therefore developed a new angiographic technique, ascending venous angiopneumography (AVAP) which successively opacifies the lower limb veins, inferior vena cava (IVC) and pulmonary arteries. It was used in 180 patients suspected of having a recent pulmonary embolism. It has three main advantages: 1) TECHNIQUE: this only involves injection of a vein on the dorsum of the foot, may be carried out in any radiological centre and is repeatable. 2) DIAGNOSIS: the investigation is more sensitive but less specific than selective angiopneumography when compared in a series of 25 cases: it was never normal in the 16 cases of pulmonary embolism, but in its absence there were 4 doubtful cases out of 8. This lack of specificity is compensated by the data obtained during the initial phlebocavographic times. The diagnosis of pulmonary embolism may be made when the context is suggestive and radiological evidence of venous thrombosis is obtained (124 cases). The diagnosis is very improbable when all phases of AVAP are normal (45 cases). 3) THERAPY: treatment should take the initial venous thrombosis into account, especially with regards to the choice of thrombolytic agents and surgical clipping of the IVC. Finally, this is a low-risk procedure.