The additional value of intraoperative angiography in infragenicular reconstruction

Abstract

IADSA could not determine when reconstruction was not possible, but in those deemed reconstructable by IADSA, the surgeon can confidently expose the appropriate artery at the appropriate level knowing the pedal run-off status in 86% of patients. IADSA should not be used to exclude reconstruction (i.e. pre-reconstruction IOA is still required in these patients) but for the remainder, IADSA can be used to plan surgical strategy without recourse to IOA.

Optimized Diagnostic Angiography in High-Risk Patients with Severe Peripheral Vascular Disease

“…Although there is no doubt that noninvasive techniques have their place, there have been no published studies, to our knowledge, that have compared any of the noninvasive techniques with the bestquality selective DSA. Even studies that claimed to describe or use "state-of-the-art," "gold standard," or "optimum" DSA produced some of the errors shown herein (3,7,18). Contrast-enhanced or other MR angiographic techniques may soon provide information equivalent to that provided by selective DSA with less risk and cost.…”

“…Much has been written about the ability of some noninvasive techniques, particularly MR angiography, to show distal vessels not visible at conventional arteriography. Even before the invention of MR angiography, it was well known that conventional arteriography often failed to show significant distal vessels (16)(17)(18). Although there is no doubt that noninvasive techniques have their place, there have been no published studies, to our knowledge, that have compared any of the noninvasive techniques with the bestquality selective DSA.…”

“…Biplane angiography of distal calf vessels allows confident identification of isolated distal arterial segments, provided frontal imaging is performed perpendicular to the interosseous membrane (Table 3). Confident identification of such segments is not always possible when single-plane imaging is used, as demonstrated in some comparative studies (9,18,19). Unsuccessful or incomplete examinations and examinations with indeterminate results are infrequent with selective DSA relative to other techniques, with which 10%-20% of segments may be uninterpretable or assessed incorrectly (9,18).…”

“…Confident identification of such segments is not always possible when single-plane imaging is used, as demonstrated in some comparative studies (9,18,19). Unsuccessful or incomplete examinations and examinations with indeterminate results are infrequent with selective DSA relative to other techniques, with which 10%-20% of segments may be uninterpretable or assessed incorrectly (9,18). Biplane angiography is also recommended to better profile lesions, which may be eccentric and over-or underestimated with single-plane angiography.…”