The incidence, etiologies, and avoidance of complications of pulmonary angiography in a large series.

Abstract

Pulmonary angiography is sensitive and specific in the diagnosis of pulmonary thromboembolism, but it remains an invasive procedure. Experience with 1,350 pulmonary angiograms was reviewed to ascertain the incidence, etiologies, and avoidance of complications. There were three deaths, all of which were secondary to cor pulmonale in patients with pulmonary hypertension and right ventricular end diastolic pressure (RVEDP) equal to or greater than 20 mmHg. Other complications consisted of cardiac perforation in 14 patients and endocardial or myocardial injury in six without sequelae, 11 significant arrhythmias and five cardiac arrests successfully treated, minor contrast material reactions in 11 patients, and a few insignificant complications. Carefully performed pulmonary angiography is safe if one avoids injecting contrast material into a patient with an elevated RVEDP.

Feasibility, safety and clinical utility of angiography in patients with suspected pulmonary embolism

“…Ultrasonography showed proximal deep experience before the start of the investigation, pulmonary angiography may be safely introduced and incorporated in a m a n a g e m e n t strategy for pulmonary embolism. The observed complication rate is comparable to that reported previously [2,[6][7][8]. The low rate in the present study m a y in part be explained by careful patient selection [8,13,18], which in turn implies that angiography may not be feasible in up to 23 % of patients.…”

“…Subsequently, the mean pulmonary artery pressure (PAP) was measured to identify patients with pulmonary hypertension. If a mean PAP of greater than 40 mmHg existed, no contrast was injected for fear of complications [7].…”

“…The existing reluctance among physicians to perform angiography is understandable in view of the fear of complications [6][7][8], the inability to perform the procedure in a considerable number of patients [9] and the unavailability of equipment and experience in many hospitals. Therefore, noninvasive diagnostic tests would be preferred and are being investigated [5,10] However, no optimal diagnostic strategy is currently available which omits the need for angiography [3,11,12].…”

Indirect detection of lung perfusion using susceptibility‐based hyperpolarized gas imaging

“…X-ray pulmonary angiography is the accepted gold standard for diagnosing PE. Still, this test is invasive, with 0.5% mortality (12); in addition, interobserver agreement is only 66% for subsegmental emboli (13). Alternatively, the initial diagnosis of PE is often done using planar ventilation-perfusion (V/Q) scanning.…”

Catheter-directed interventions for pulmonary embolism

“…Normal RA pressures are 0-5 mmHg; RV pressures are 20-25 mmHg; and PA pressures are 20-25 mmHg systolic and 10-15 mmHg diastolic, with a mean pressure of 9-18 mmHg. In the case of elevated PA pressures, high volume injections for pulmonary angiography are best avoided (42). Suggested injection rates from the experience at our institution include 20 mL/sec over 1 sec in the lobar arteries, which could be lowered to 10 mL/sec for 2 sec in the lobar PAs if pulmonary hypertension is present (17,43).…”