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[Postoperative digital subtraction angiography after infrainguinal bypass operation]
U Kugelmann1, K D Wölfle, H Loeprecht
1Klinik für Gefäss- und Thoraxchirurgie, Zentralklinikum Augsburg.
Zentralblatt Fur Chirurgie
|January 1, 1995
Summary
Early postoperative DSA identifies critical bypass defects missed during surgery. This imaging technique improves infrainguinal arterial reconstruction outcomes by detecting issues before they cause bypass failure.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Interventional Radiology
Background:
- Infrainguinal arterial reconstructions are prone to early bypass occlusions, often due to technical defects.
- Up to 20% of bypasses experience occlusion within the first postoperative month.
- Identifying and correcting these defects is crucial for long-term graft patency.
Purpose of the Study:
- To evaluate the diagnostic value of early postoperative intraarterial digital subtraction angiography (DSA) in infrainguinal bypass grafting.
- To compare the findings of postoperative DSA with intraoperative angioscopy and completion angiography.
- To assess the ability of early DSA to detect initially unrecognized or secondary bypass defects.
Main Methods:
- A prospective study involving 103 patients undergoing infrainguinal bypass grafting.
- 81 bypasses were examined using intraarterial DSA 10 days postoperatively.
- Findings were compared with intraoperative angioscopy and completion angiography results.
Main Results:
- Early postoperative DSA identified additional pathological findings in 11 cases (13.6%).
- Six proximal anastomotic stenoses, missed intraoperatively due to technical reasons, were visualized.
- Postoperative DSA revealed distal recipient artery occlusions and other defects like fistulas and stenoses not detected by other methods.
Conclusions:
- Early postoperative DSA is essential for identifying initially unrecognized and secondary bypass defects in asymptomatic patients.
- This imaging modality provides a final scrutiny of arterial reconstruction, allowing for timely intervention before monitoring with non-invasive methods.
- Intraoperative DSA can examine proximal anastomoses, but early postoperative DSA offers a more comprehensive assessment of the entire reconstruction.