Intravenous digital subtraction angiography and helical computed tomography in evaluation of living renal donors

OBJECTIVES: The present study was carried out to evaluate the accuracy of helical computed tomography (CT) and intravenous digital subtraction angiography (IV-DSA) on anatomical assessment of renal vasculature for living renal donors. METHODS: Forty-two healthy potential renal donors were prospectively evaluated and 35 subsequently underwent donor nephrectomy after helical CT and IV-DSA evaluation. The vascular and non-vascular findings were compared between the findings on helical CT, IV-DSA and surgery. RESULTS: Ten prehilar branches and five accessory renal arteries were found at nephrectomy. Overall, operative findings agreed with the findings by IV-DSA in 89% and by helical CT in 83%. In delineating accessory arteries, IV-DSA had a sensitivity of 60% and specificity of 97%, whereas helical CT had a sensitivity of 40% and specificity of 100%. In delineating prehilar branches, IV-DSA had a sensitivity of 90% and specificity of 100%, whereas helical CT had a sensitivity of 70% and specificity of 100%. Accessory arteries and prehilar branches that were not detected by helical CT or IV-DSA, were less than 2 mm in diameter and did not require vascular reconstruction. Renal veins were delineated in 63% by IV-DSA, whereas they were clearly imaged by helical CT in all cases, including a case with a circumaortic renal vein. Non-vascular findings were obtained in 64% by helical CT, including two renal tumors. None of these findings were obtained by IV-DSA. CONCLUSION: Helical CT and IV-DSA provide comparably sufficient information on renal artery vasculature. However, helical CT provides significantly more information on venous and non-vascular findings as a single-imaging modality.     

Intravenous digital subtraction angiography in intensive care

Intravenous digital subtraction angiography (IVDSA) was performed in 11 patients aged from 23 to 62 yr to visualize vascular disease that required to be treated without delay: 7 were in shock preceded by a cardiac arrest in 5 of them; 4 suffered from acute renal failure, 8 from acute respiratory failure and one from brain death. 5 pulmonary, 2 thoracic aortic, 3 abdominal aortic, 1 right subclavian and 1 renal arterial angiographies were carried out by this method. In all the cases described, we either confirmed the diagnosis (rupture of thoracic aorta, type I aortic dissection, aneurysm of abdominal aorta, complete occlusion of the distal abdominal aorta, pulmonary embolism) or set aside diagnosis (lesion of the subclavian vessels, pulmonary embolism) or visualized the renal vasculature before removing the organ. No incident was observed. Conventional angiography remained a reference method but it presented risks which were not to be neglected in critically ill patients. Despite the theoretical limits set by the technical demands (absolute motionlessness, apnoea) and few other restrictions found in the literature, IVDSA seemed to offer distinct advantages under such conditions. Only requiring an injection using a catheter placed in a peripheral vein, this method was fast, safe and easy; it gave a close enough approach to the diagnosis to be able to help decide on specific treatment or on orientation towards a specific hospital department.     

Intravenous digital subtraction angiography for the evaluation of renal artery blood flow following the removal of a neuroblastoma

There have been several reports of acute renal failure following the resection of an abdominal neuroblastoma combined with ipsilateral nephrectomy as well as the atrophy or disappearance of an unresected kidney after tumor resection. Spasms or thrombosis of the renal artery during tumor excision are considered to be the major cause. Since 1989, intravenous digital subtraction angiography (IVDSA) has been used to evaluate the renal artery blood flow immediately following surgery in seven patients with abdominal neuroblastomas. IVDSA was performed using a central venous catheter inserted prior to surgery. In all seven patients, IVDSA provided clear images for the evaluation of renal artery blood flow. In one of the two patients whose kidneys briefly became cyanosed during tumor excision, IVDSA demonstrated an occlusion of the renal artery and prompt measures could be taken to reestablish the blood flow. No complications of IVDSA occurred in any of the seven patients. IVDSA using a central venous catheter was thus considered to be useful for evaluating the renal artery blood flow in patients with a suspected renal artery blood flow disturbance without any risk of complications, and this modality obviated the need for intraarterial angiography.     

Evaluation of renal intra-arterial digital subtraction angiography

A total of 68 patients with renal abnormalities and potential donors were examined by intra-arterial digital subtraction angiography (IA-DSA). Compared with the conventional angiography, the advantages of IA-DSA are reduction of volume of contrast material and rate of injection. The image quality is superior to intravenous DSA. For the potential donors, IA-DSA has the same diagnostic value as conventional angiography to depict the number and position of renal arteries. IA-DSA is an effective method for screening hypertensive patients for renovascular disease. However, conventional angiography is necessary when evaluation of smaller intra-renal branch is desired. IA-DSA would be valuable for renal recipients because of good visibility by a smaller volume of contrast material. Another advantage of IA-DSA is the reduction of examination time. Embolization can also be done in a shorter time. Renal vein is easily detected by IA-DSA. Renal vein anomalies and obstruction are diagnosed in the left side without conventional venography. Renal IA-DSA can be replaced by conventional arteriography except when the delineation of tiny arterial change is desired.     

Intravenous digital subtraction angiography for extracranial carotid artery disease

Intravenous digital subtraction angiography is relatively hazardous and inaccurate. It appears from the literature to have little place in either the screening of patients with putative carotid artery disease or in the assessment of those about to undergo carotid endarterectomy.     

Computed tomographic angiography in the preoperative evaluation of potential renal transplant donors

The preoperative screening of potential renal transplant donors has undergone a major evolution with the introduction of computed tomographic angiography. With computed tomographic angiography, the radiologist is able to provide the surgeon with precise and valuable preoperative details of renal arterial and venous anatomy. In addition, computed tomographic angiography provides valuable information regarding the renal parenchyma and adjacent organs. This helps reduce the risks and complications associated with transplant surgery and improves the chances of a successful outcome. Helical computed tomographic angiography is rapidly replacing intravenous urography and conventional angiography as the imaging modality of choice for evaluating renal donors.     

Intravenous digital subtraction angiography in the management of peripheral vascular disease.

All patients undergoing peripheral injection intravenous digital subtraction angiography (ivDSA) for peripheral vascular disease during 1987 have been reviewed (140 patients). The radiological distribution of disease was aorto-iliac occlusive (AI) 36 (23%), femoropopliteal (FP) 68 (44%), mixed AI/FP 36 (23%). Clinical diagnosis was correct for AI disease in 92%, for FP disease in 65% and for mixed AI/FP disease in 47%. ivDSA was the only investigation required for management in 111 of all 140 patients (79%), and in 33 of the 36 patients with AI disease (92%), but was less accurate in defining femoropopliteal disease, 22 patients (32%) requiring additional arteriography. Conventional arteriography was performed in 200 patients in 1982 compared with 100 in 1987. ivDSA is particularly suitable for the investigation of AI disease, a condition which is accurately detected by clinical examination, with a reduction in morbidity and bed occupancy.     

Intravenous digital subtraction angiography in the assessment of patients for carotid endarterectomy

Preoperative intravenous digital subtraction angiography (IV DSA) was compared with the operative findings in 54 patients who underwent a total of 57 carotid endarterectomies, to evaluate the accuracy of preoperative IV DSA in predicting the lesion found at surgery. Four studies early in the series were technically unsatisfactory, leaving 50 patients with 53 procedures for evaluation. Severe carotid artery stenosis was accurately predicted in all cases. Deep ulceration in the absence of severe carotid stenosis was reliably shown by IV DSA, although it was not reliably demonstrated by either IV DSA or carotid angiography if severe stenosis was also present. As severe carotid stenosis or deep ulceration are the major radiological indications for carotid endarterectomy, the authors have found that technically satisfactory IV DSA is an adequate preoperative imaging technique.     

Intravenous digital subtraction arteriography in the evaluation of vascular grafts

Between 1982 and 1986 intravenous digital subtraction arteriography was used to evaluate vascular grafts in 97 patients (54 males, 43 females). Indications included recurrent symptoms, absent or diminished pulses, a drop in Doppler pressure measurements, and clinical uncertainty with respect to graft patency. Problems identified included graft stenosis, stenosis of the anastomosis or its distal vessels, false aneurysm, arteriovenous fistula and emboli. Forty-eight operations were carried out following intravenous digital subtraction arteriography, and radiographic findings were verified surgically. Twice, intravenous digital subtraction arteriography did not show significant graft findings which were discovered at surgery. Thus intravenous digital subtraction arteriography showed a sensitivity of 95.8% and specificity of 100%. Complications following intravenous digital subtraction arteriography were: two patients developed urticaria, and one superficial thrombophlebitis. There were no cases of pulmonary edema or death. In conclusion intravenous digital subtraction arteriography is very useful in the diagnosis of graft-related problems if done on a selective basis looking at graft and anastomosis site only, intravenous digital subtraction arteriography is done on an outpatient basis, has high sensitivity and specificity, good patient acceptance, is safe, fast and is less expensive than conventional arteriography.     

Digital subtraction angiography for renal donor evaluation

A consecutive series of 52 living related renal donors were evaluated preoperatively by angiography. The preoperative angiographic interpretation was compared with the anatomy found at donor nephrectomy. Standard selective renal arteriography was found to be 100 per cent accurate in defining single (25) or multiple (1) renal arteries. Digital subtraction angiography (DSA) alone performed with an intra-arterial injection of contrast material was found to be 82 per cent accurate in determining the number of renal arteries. In five kidneys with multiple renal arteries, only two had the correct number of vessels identified. The errors are inherent in the DSA technology. DSA at the present time is not accurate enough to replace the standard arteriogram in the evaluation of the donor nephrectomy patient.     

数字减影血管造影在四肢血管损伤诊断中的应用

数字减影血管造影（digital subtraction angiography．DSA）是诊断血管损伤的重要工具。本院自1998年开展DSA技术以来，对28例高度怀疑有血管损伤的外伤患者进行了DSA检查，确诊21例，符合率占75％，现报道如下。     

Renal digital subtraction angiography

Renal digital imaging has progressed rapidly in reliability and potential since its clinical introduction in 1979. The advent of larger image intensifiers has made feasible subtraction imaging of the renal parenchyma and collecting systems as an adjunct to IV-DSA. The growing use of IA-DSA has expanded the utility of the technology to the examination of the intrarenal circulation, contrast-sensitive patients, and the performance of interventional procedures. There are experimental works suggesting that it may be feasible to derive accurate physiologic data reflecting renal blood flow and excretion from sequential alterations in intravascular contrast density. Thus, anatomic abnormalities and their significance might conceivably be determined, with minimal patient discomfort, from the same imaging procedure. The development of digital imaging technology and techniques continues to be of major interest to both academic and commercial investigators. Thus, further improvements in digital imaging and expansion of its capabilities are likely to occur.     

Usefulness of digital subtraction angiography for diagnosis of renal tumours

DSA (digital subtraction angiography) is a new, highly effective method for visualization of kidney vascular system. By means of a digital subtraction angiography unit the image of bones and soft tissues is blotted out, and a subtractive picture of contrasted vessels alone emerges. Intra-arterial DSA is a less invasive and more comfortable method when compared to conventional angiography. Only 2–4 ml of contrast medium is administered, thinner catheters being employed at the same time. The examination can also be performed through intravenous administration of contrast medium. The DSA unit Angiotron CMP was installed at the Department of Radiology, Military Medical Academy of Łódź, in 1984. In the present material a diagnostic DSA investigation was performed in 22 patients with renal tumours. In 21 of them the tumour was correctly diagnosed on grounds of pathological vascularization and the result was dubious in only 1 patient with benign tumour.     

Intravenous digital subtraction angiography: its use in evaluating vascular injuries in children

Angiography is often essential in the evaluation of patients with suspected vascular injuries. However, arterial cannulation has a significant inherent complication rate, especially in small patients. Therefore, a less invasive method of evaluating children with such injuries is desirable. We report nine children (age range, 9 months to 16 years; median, 7 years) in whom intravenous digital subtraction angiography (IV-DSA) was used to evaluate suspected vascular injuries. IV-DSA showed a false aneurysm in two children, one managed by ligation alone and the other by resection with primary anastomosis. One child was found to have an arteriovenous fistula, which was treated by ligation. An iliac occlusion, following an arteriogram to evaluate a liver tumor, was documented by IV-DSA and successfully managed with aggressive anticoagulant therapy. Demonstration of a normal vascular tree avoided exploration in four children. A planned skin flap was abandoned in a child who suffered an electrical injury when IV-DSA showed lack of adequate vascular supply. In all nine cases, the IV-DSA obviated the need for intraarterial angiography. In addition to avoiding arterial cannulation, IV-DSA required significantly less radiation and less time to perform than conventional arteriography. Motion artifact, vessel overlap, and some loss of minute detail are some of its potential shortcomings. IV-DSA is an effective method of screening children with suspected vascular injuries. In addition, our experience has shown that IV-DSA can be the definitive diagnostic procedure, although intraarterial angiography may be necessary in selected cases.     

Intra-arterial digital subtraction angiography in the evaluation of peripheral vascular trauma.

The role of intra-arterial digital subtraction angiography (IADSA) in the evaluation of extremity trauma has not been clearly established. Several potential advantages would make IADSA a preferable study to conventional angiography (CA). This retrospective study analyzed 104 major peripheral arteries with suspected injury. Multiplane IADSA studies were compared with conventional angiography of the same vessel in 97 patients. The arteriograms were evaluated by a physician and a radiologist in a double-blinded fashion. IADSA correlated well with CA. Similar findings comparing both studies were noted in 101 of 104 angiograms (97%) (p less than 0.001) in review by the radiologist and in 100 of 104 (96%) (p less than 0.001) by the surgeon. Only one injury confirmed at surgery was not seen on IADSA; this study was read as equivocal by both examiners. These data confirm that IADSA is a reliable and reasonable study for the evaluation of patients with suspected peripheral arterial injury.     

Intravenous digital subtraction angiography and its use in amputation level consideration in the ischemic forefoot

This case report utilizes a recently popularized method of radiologic examination for peripheral vascular disease. In a diabetic foot with osteomyelitis, ischemia, and gangrene we have assessed patent arterial supply in the distal arterial tree. This examination has allowed the authors to accurately predict wound healing potential preoperatively at a specific anatomic level.     

The role of digital subtraction angiography in the diagnosis of renal artery injury

In 3806 patients with vasorenal hypertension the results of kidney angiographic investigation were analyzed. In order to study the efficacy of application of intravenous digital substructional angiography (DSA), the data, obtained in 1621 patients using this method, were compared with such in general group of patients. Informativeness of DSA had constituted 88.9%. Accompanying chronic disease of intestine, excessive body mass, nephrosclerosis are complicating interpretation of obtained results in 10.1% of observations. Possible conduction of ambulatory investigations, decrease traumaticity, invasiveness, duration of procedure, shortening of financial expense constitute the main advantages of DSA. Application of method is recommended in all patients with vasorenal hypertension in ambulatory environment.