Digital subtraction angiography for examination of vessels of the leg: use of a 40-cm image intensifier.

Digital subtraction angiography (DSA) using a 41-cm (16-in.) image intensifier was performed in 144 patients with peripheral vascular insufficiency. In most cases the entire peripheral vascular bed from the renal arteries to the popliteal trifurcation was demonstrated with four intravenous injections and four exposed fields: (a) aorto-iliac, (b) ilio-femoral, (c) femoro-popliteal, and (d) popliteo-tibial. In 90% of cases the procedure was diagnostic in all regions studied, while in 10 it was nondiagnostic in one or more regions for various reasons (myocardial insufficiency, inadequate contrast bolus, or technical failure). Most failures involved the distal arteries. In spite of some limitations, intravenous DSA using a large-field image intensifier may replace conventional angiography in routine preoperative evaluation of peripheral vascular disease, with intra-arterial injections being performed when the intravenous technique is nondiagnostic.