McGraw, J. Y.
June 1963
Angiology;Jun1963, Vol. 14 Issue 6, p306
Academic Journal
The subject of direct and retrograde arteriography is discussed and reviewed. Aortography, both by the translumbar needle method and by the method of retrograde catheterization of the aorta has in our experience been a practical, safe, dependable and often useful procedure. But because retrograde catheterization is not as simple and innocuous as direct aortography, we do not believe that it should ever become a routine diagnostic procedure. It has unquestionably great use in vascular lesions involving the aorta and its branches where correct indications and a correct planning for the operation need a diagnosis that among other things contains a detailed anatomic investigation of the vascular anomaly in question. Except for visualization of the renal arteries, or due to inability to needle the small aorta in children, retrograde abdominal aortography offers no advantages over the translumbar method, and there are definite practical disadvantages. In visualizing the thoracic aorta, however, the direct approach has been far less popular or successful than the retrograde route. Because of difficulties in positioning the tip of the catheter, poor visualization, or incidence of serious cerebral complications when the contrast medium is introduced into the arteries of the upper extremity or the common carotid artery, we feel that the percutaneous femoral artery catheterization method is better suited for thoracic angiography. By passing the catheter through the femoral artery and placing the tip of the catheter at various levels in the aorta, it is possible with small amounts of relatively weak solutions of contrast media to obtain clear and detailed arteriograms of any portion of the aorta, including the aortic arch and its branches, the proximal aorta, the coronary arteries, the aortic valves and the left ventricle. Although retrograde arteriography is not universally practiced at present, the growing importance of this study in the more accurate diagnosis of arterial lesions encourages its more widespread employment; in some cases the examination may save the patient from an unnecessary thoracotomy or laparotomy. At the same time the procedure is not without danger; for this reason the report of five untoward reactions is cited, and in addition the various complications both local and systemic following arteriography are discussed. The methods of direct and retrograde arteriography are compared. It is concluded that translumbar needle aortography is simpler and less hazardous and should be the method of choice in all suitable cases. Retrograde arteriography should be restricted to those patients in whom it is difficult or impossible to introduce the radiopaque substance into the artery proximal to the lesion. Emphasis is placed on the complications which may result from the use of this method.


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