Blakeman B M, Littooy F N, Baker W H
J Vasc Surg. 1986 Aug;4(2):168-73.
In many patients with peripheral vascular disease, conventional arteriograms are not adequate to make proper preoperative decisions. In the past, these inadequate studies led to surgical exploration of vessels and intraoperative angiography to determine operability. Such efforts prolonged operating time and potentially had adverse effects on amputation levels. Recently, intra-arterial digital subtraction angiography (IDSA) has provided an excellent means to further evaluate these patients preoperatively. We presently have 30 patients in whom IDSA supplemented routine aortography and runoff studies. When standard angiographic studies were considered inadequate, the catheter was positioned appropriately and IDSA was obtained. Inadequate lower extremity distal runoff in 23 patients and no proximal or distal runoff in seven patients prompted the IDSA. The IDSA study yielded further information on all patients, and 26 of 30 patients underwent successful bypass operation. In all 17 patients having femoropopliteal or femorotibial bypass, the IDSA was confirmed by an intraoperative (after bypass) angiogram. Nine patients had inflow procedures, and operative findings corroborated the IDSA. Two patients refused surgery and two patients were not candidates for revascularization. The IDSA study provided an accurate "road map," eliminated unnecessary vessel exploration, saved vital operative time, and prevented compromise of potential amputation levels.
在许多外周血管疾病患者中，传统动脉造影不足以做出恰当的术前决策。过去，这些不充分的检查导致对血管进行手术探查以及术中血管造影以确定手术可行性。此类做法延长了手术时间，并可能对截肢平面产生不利影响。最近，动脉内数字减影血管造影（IDSA）为术前进一步评估这些患者提供了一种极佳的方法。我们目前有30例患者接受了IDSA检查，该检查补充了常规主动脉造影和下肢动脉造影。当标准血管造影检查被认为不充分时，将导管恰当定位并进行IDSA检查。23例患者下肢远端动脉血流不足，7例患者远近端均无动脉血流，促使我们进行IDSA检查。IDSA检查为所有患者提供了更多信息，30例患者中有26例成功接受了搭桥手术。在所有17例接受股腘或股胫搭桥手术的患者中，IDSA检查结果在术中（搭桥术后）血管造影中得到证实。9例患者接受了流入道手术，手术结果证实了IDSA检查结果。2例患者拒绝手术，2例患者不适合进行血管重建。IDSA检查提供了一份准确的“路线图”，避免了不必要的血管探查，节省了关键的手术时间，并防止了可能的截肢平面受到影响。
