Supplementary angiography when lumbar angiograms fail to demonstrate the vessels to the leg.

The peripheral run-off arteries were insufficiently visualized due to occlusions in the aorto-iliac segments in studies of 10 patients (15 legs) in 183 consecutive aorto-femoral angiograms. Guided by a combination of the Doppler technique and fluoroscopy, the non-opacified and pulseless common femoral artery was catheterized. Angiography through this catheter usually showed patency of a part of the common femoral artery but occlusion of the superficial femoral artery. The deep femoral and crural arteries were well preserved. Intra-arterial pressure measurements showed larger pressure gradients along the occluded aorto-iliac segments in one-third of the patients with non-visualized leg arteries as compared with gradients in patients with similar proximal and distal occlusions but with good opacification of the leg arteries. In previous cases, non-visualization of the leg arteries was considered as representing non-reconstructable lesions by our vascular surgeons. The findings in the present study showed that in these patients surgical reconstruction of only the aorto-iliac segments will suffice to save the limb from amputation.