Brian

D. Fellmeth,

Rapid Disease

MD,

PhD2

#{149} Joseph

terms:

Angiography,

#{149} Arteries,

92.442

peripheral.

stenosis

or obstruction,

luminal

angioplasty,

thrombosis,

92.721

92.128

complications, 92.721 #{149} Arteries, #{149} Arteries, trans#{149} Extremities,

92.442

Radiology

MD

1990;

175:71-74

T

natural history of atherosclerotic disease of peripheral yesis one of slow progression of

sels

sity

the

Department

of California,

225

Dickinson ceived June

revision vember 2

Medical 3

San

Current

of Radiology,

Diego

Medical

St. San Diego, 5, 1989; revision

received Address

November reprint

6.

Current

address:

Group.

phy

has

been

reported

of patent but terial segments

issue.

#{149} Joseph

Inc.

address:

Center,

CA 92103. requested

ReJuly

3; accepted Norequests to J.J.B.

Sacramento

Radiology

Sacramento,

Calif.

Department

of Radiology,

1990 the editorial

3;

P. Dillard,

MD4

(p 33) in this

(5).

diseased shortly

ca-

Occlusion

peripheral amafter diagnos-

has

literature (6-8). The to complete occbu-

sion

been

is attributable

discussed

to acute

posed thrombosis. While angiognaphic thrombosis tune site can be anticipated

nature

of this

artery.

of the

standard

acute penat the puncin 0.15%

was performed by means of the and with use

Seldinger

technique.

In

case 1, diagnostic angiognaphy was performed in an outside institution, and some details (eg, the contrast material used, drugs given, and possible difficulties with the puncture) are uncertain, In cases 2-7, no hepanin was used, other than

small

eter.

All angiographic

cut-film

supemim-

of femona! angiograms (9), the unexpected finding of thrombosis occurring remote from areas of puncture or catheter manipulation prompted our investigation of the frequency

and

cases of thrombosis after PTA of leof the lower superficial femonal or

popliteal

in the European rapid progression

amounts

for

flushing

the

studies

aortography

and

cath-

included

cut-film

run-off

angiognaphy with either digital technique or cut-film pelvic oblique views. A variety of contrast agents were used. In two cases (29%), high-osmolality agents were used exclusively. In the other five cases (70%), low-osmolality agents were used exclusively, with the exception of lO-25-mL test injections of iothalamate meglumine 60%.

phenomenon. RESULTS

MATERIALS The

AND

angiographic of California,

Center

and the

La Jolla

Hospital

were

istration period

between

cemben

METHODS

log books

versity

San

Diego

Uni-

Medical

Veterans

Admin-

examined

January

31, 1988.

at the

1, 1986

for the and

De-

log at the Alvanado Medical Center, San Diego was examined for the period of January 1 to December 31, 1988. One hundred seventy-five cases were identified in which percutaneous

The

angioplasty

(PTA)

or

throm-

between the aortic knee. Arteniography within the previous

in approximately

75 cases,

and

treatment had been performed immediately after the initial diagnostic study in the other cases. Cases of occlusion occurring in the interim between diagnostic angiography and the attempted nevasculanization constitute the seven cases reported in this article. Other cases, in which disease progressed in a segment that had or catheter initial

by Picus

three sions

tic angiography

3 months

Univer-

Alvarado Medical Center, San Diego. 4 Current address: Department of Radiology, Pomerado Hospital, Poway, Calif. C RSNA, See also

MD3

Diagnostic angiography with 5-F pigtail catheters common femonal approach

multifocal stenotic foci with occasional thrombosis of arterial segments where the flow is critically slowed (1-4). Occlusion of severe notid artery stenosis after angiogna-

transluminal

From

L. Lunie,

HE

bolysis was attempted bifurcation and the had been performed I

#{149} Alan

Progression of Peripheral Vascular after Diagnostic Anglography’

The authors retrospectively meviewed records of percutaneous transluminal angioplasties performed at three institutions. Seven stenotic lesions in peripheral vessels were identified that had progressed to total occlusion in the interval between the time that diagnostic runoff angiography and attempted angioplasty were performed. The postangiographic occlusions were 3-16 cm long (mean, 9 cm), and the interval between diagnostic angiography and discovery of the occlusions ranged from 1 hour to 91 days (median, 2 days). Treatment of the occlusions was riskier and more difficult than simple angioplasty of the original stenoses. The authors condude that some aspect of the angiographic procedure probably precipitated the transition from stenosis to occlusion. This complication can be prevented by preparation for angioplasty immediately after diagnostic run-off angiography or perhaps by use of heparin during the diagnostic study. Index

Bookstein,

J.

been crossed on otherwise

angiography,

included oral

puncture

one

with were

a guide manipulated excluded.

case

of thrombosis

site

during

the

wine at These

at a fernhold

and

We identified occlusive disease routine

seven cases developed

diagnostic

performed. sion

was

discovered for

was

the new

during

performed

preparation

case,

angiography

In six cases,

giography

in which soon after

PTA.

the thrombosis

occbu-

repeat

1-91

an-

days

In the

later

in

seventh

developed

while

the patient waited for 1 hour on the angiographic table for surgical consultation. In six cases, the new occlusion mequired thrombolysis, which increased the difficulty, risk, and expense of transcatheter therapy. The seventh case

was

excluded

ment sion.

because

The

from of the

pertinent

cases

are

New

occlusions

data

percutaneous extent

treat-

of occbu-

for the seven

summarized

in the

occurred

Table.

in four

super-

ficial femorab arteries, one popliteab amtery, one iliac artery, and one reversed saphenous bypass graft from the femonab artery to the popliteal artery below the knee. All seven of the initial lesions

were quent

short, high-grade stenoses. angiograms demonstrated

sions

ranging

from

3 to

16 cm

Subseocclu(mean,

9

71

cm). The length nostic angiography

of time and

of the subsequent

between diagthe discovery

occlusion

ocpuncdevel-

oped

to the

on the side

puncture. discernible

2

Five patients (70%) change in symptoms

the occlusion

had

a

.

.2

‘5 .5

bO

bC

a

a’

‘c

E

contralateral

,

,,,a,

0.

‘

‘O

‘O

‘

C”r’

0 U

.5

n0

er.iO.nO

o, .

E ca)I.

a

I-

F-

Eu

‘i

c”

F-

1-.

,

,-

so. Reports

-

68-year-old was referred

out phy

to

evaluate

tion

of 1-year

calf

duration.

mild to moderate superficial femoral

diffuse artery

claudica-

was then (Fig lb).

test 12-cm

.0

documented

bowed

by angioplasty.

demonstrated single run-off came acutely

and

clinically

Case

5.-A

The

left

femomal

pulse

artery

artery sebs

(Fig

was were

2a).

The

occluded. patent

consultation

Distal

for PTA

sis was not available, was removed.

Two for

days

elective

later,

the

a digital

demonstrated left

(Fig

common

2b). The

subtraction

occlusion and

iliac

was

Radiology

#{149}

r’

‘

0

‘O

.c ‘

c

-

.E

-a uuu

0.

a ‘o 2n

‘0

,,2n

a:,.

l

.do

)O

c .c s9

a

.

‘

0.

0

.