Digital subtraction angiography and B-mode ultrasonography for abdominal and peripheral aneurysms

Thirty-two patients suspected of having intraabdominal and/or peripheral aneurysms were evaluated by digital subtraction angiography (DSA) and B-mode ultrasonography to determine whether diagnostic accuracy and operative management could be improved by this combination of preoperative studies. Abdominal B-mode ultrasonography accurately diagnosed most primary aortic aneurysms and correctly determined their size (93%) but missed iliac artery aneurysms in 75% of cases. Failures resulted from severe ileus and the inability to scan the intrapelvic iliac vessels. Abdominal ultrasound studies were false positive for aortic pseudoaneurysms in two of four cases. DSA correctly identified all but one intra-abdominal aneurysm but did not always correctly determine their size because of intraluminal clot. DSA identified a number of associated peripheral vascular lesions, which ultrasonography could not. All primary peripheral aneurysms were correctly diagnosed by ultrasound, but nearly half of the ultrasound studies were false positive for femoral pseudoaneurysms. DSA correctly identified all peripheral aneurysms and at the same time provided anatomic information about vessels proximal and distal to these lesions needed for surgical planning. Digital subtraction angiography combined with ultrasonography is diagnostically accurate and provides adequate anatomic information for planning surgical management of these aneurysms.