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Supplementary angiography when lumbar angiograms fail to demonstrate the vessels to the leg
Insights
Aorto-iliac segment occlusions can cause poor visualization of leg arteries. Surgical reconstruction of these segments may be sufficient to save limbs from amputation.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Peripheral artery disease (PAD) often involves aorto-iliac occlusive disease.
- Poor visualization of distal arteries can lead to misdiagnosis of non-reconstructable lesions.
Purpose of the Study:
- To investigate the cause of poor visualization of peripheral run-off arteries in patients with aorto-iliac occlusions.
- To determine if aorto-iliac segment reconstruction is sufficient to salvage limbs in such cases.
Main Methods:
- Analysis of 183 aorto-femoral angiograms in 10 patients with aorto-iliac occlusions.
- Utilized Doppler technique and fluoroscopy for catheterization of the common femoral artery.
- Performed intra-arterial pressure measurements to assess pressure gradients.
Main Results:
- Insufficient visualization of peripheral arteries was noted in 15 legs due to aorto-iliac occlusions.
- Deep femoral and crural arteries were often well-preserved despite proximal occlusions.
- Larger pressure gradients were observed in patients with non-visualized leg arteries.
Conclusions:
- Non-visualization of leg arteries in PAD may not indicate non-reconstructable distal disease.
- Surgical reconstruction limited to the aorto-iliac segments can potentially salvage limbs.
- This approach may prevent unnecessary distal interventions or amputation.
Abstract:
The peripheral run-off arteries were insufficiently visualized due to occlusions in the aorto-iliac segments in studies of 10 patients (15 legs) in 183 consecutive aorto-femoral angiograms. Guided by a combination of the Doppler technique and fluoroscopy, the non-opacified and pulseless common femoral artery was catheterized. Angiography through this catheter usually showed patency of a part of the common femoral artery but occlusion of the superficial femoral artery. The deep femoral and crural arteries were well preserved. Intra-arterial pressure measurements showed larger pressure gradients along the occluded aorto-iliac segments in one-third of the patients with non-visualized leg arteries as compared with gradients in patients with similar proximal and distal occlusions but with good opacification of the leg arteries. In previous cases, non-visualization of the leg arteries was considered as representing non-reconstructable lesions by our vascular surgeons. The findings in the present study showed that in these patients surgical reconstruction of only the aorto-iliac segments will suffice to save the limb from amputation.