Gattoni F, Baldini U, Pozzato C, Nessi R, Raiteri R, Opocher E, Santambrogio R, Uslenghi C
Istituto di Scienze Radiologiche, Università, Ospedale San Paolo, Milano.
Radiol Med. 1990 Sep;80(3):321-4.
We report the results of intra-arterial digital subtraction angiography (DSA) in 100 patients with portal hypertension. The portal venous system was evaluated; all patients underwent angiography of the celiac and superior mesenteric arteries before surgery. Forty-four of them were also examined after Warren splenorenal shunts. Therefore, a total of 144 exams was evaluated. The authors always employed low-osmolality ionic and non-ionic contrast media (iodine concentration: 300-350 mg/ml). In 70 cases pure contrast medium was injected (20-25 ml); in the extant 74 cases it was diluted with an equal volume of saline solution (osmolality and iodine concentration reduced by 50%). Intra-arterial DSA always visualized portal venous system, collateral circulation, shunt location and postoperative changes. The major advantage of intra-arterial DSA is the smaller amount of contrast medium injected, so that local and systemic side effects are rare. According to our experience, it is best to dilute the contrast medium and inject the same amount as in conventional angiography, at the same rate. Other well-known advantages of intra-arterial DSA are quicker execution, less injury to arteries using smaller-caliber catheters, and low cost. The major disadvantage of intra-arterial DSA, as it appeared also in our study, is the field size of the intensifier, which in our case was limited to 6-9 inches. This is an insufficient coverage for the whole portal system to be studied, and some contrast medium injections become therefore necessary. An average of 3 injections were given to each patient. This problem reduces the advantage of less contrast medium per injection. At any rate, even though intra-arterial DSA exhibits this limitation, it can nevertheless yield important information in the pre- and postoperative evaluation of patients with portal hypertension.
我们报告了100例门静脉高压患者的动脉内数字减影血管造影（DSA）结果。对门静脉系统进行了评估；所有患者在手术前均接受了腹腔干和肠系膜上动脉造影。其中44例在进行Warren脾肾分流术后也接受了检查。因此，共评估了144次检查。作者始终使用低渗离子型和非离子型造影剂（碘浓度：300 - 350 mg/ml）。70例患者注入纯造影剂（20 - 25 ml）；其余74例则用等体积的生理盐水稀释（渗透压和碘浓度降低50%）。动脉内DSA总能显示门静脉系统、侧支循环、分流位置及术后变化。动脉内DSA的主要优点是注入的造影剂用量较少，因此局部和全身副作用罕见。根据我们的经验，最好将造影剂稀释，并以与传统血管造影相同的速率注入相同量的造影剂。动脉内DSA的其他众所周知的优点包括执行速度更快、使用较小口径导管对动脉的损伤更小以及成本较低。动脉内DSA的主要缺点，正如我们的研究中也出现的那样，是增强器的视野大小，在我们的病例中仅限于6 - 9英寸。这对于整个要研究的门静脉系统来说覆盖范围不足，因此需要进行一些造影剂注射。每位患者平均进行3次注射。这个问题降低了每次注射造影剂用量较少的优势。无论如何，尽管动脉内DSA存在这一局限性，但它仍能在门静脉高压患者的术前和术后评估中提供重要信息。
