Lower Extremity Angiography: Improved Image Quality and Outflow Vessel Detection with Bilaterally Antegrade Selective Digital Subtraction Angiography: A Blinded Prospective Intraindividual Comparison with Aortic Flush Digital Subtraction Angiography

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RATIONALE AND OBJECTIVESTo introduce routine bilaterally antegrade selective stationary digital subtraction angiography (DSA), and prospectively compare it with unselective stationary DSA in the detection of calf arteries and assess additional time and complication rate.METHODSTwenty-five patients received one unselective and two separate antegrade selective studies of each calf. Images were evaluated for image quality, number of depicted run-off vessels, and potential crural bypass recipient arteries.RESULTSBilaterally antegrade selective DSA was significantly superior in image quality and motion artifacts (P <0.01). The number of adequately depicted run-off arteries per calf increased from 79% (2.37 of 3) to 96% (2.89 of 3) for legs with advanced peripheral vascular disease (PVD). Seventy-nine instead of 62 potential bypass recipients were identified (P = 0.002). Mean procedure time needed for selective catheterizations was 7 minutes. No adverse events were seen.CONCLUSIONSBilaterally antegrade selective DSA clearly is superior to aortic run-off DSA depicting tibial arteries. It requires comparatively small additional effort. Outflow vessel detection essentially is independent of advanced PVD.

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