#18 LOWER EXTREMITY CARBON DIOXIDE
ANGIOGRAPHY: UTILITY OF GADODIAMIDE CONTRAST TO SALVAGE DISTAL
RUN-OFF.
Alan Herr, MD, R. Clement Darling, III, MD, Brian Stainken, MD,
Benjamin B. Chang, MD, William E. Lloyd, MD, Philip S.K. Paty, MD,
Paul B. Kreienberg, MD, and Dhiraj M. Shah, MD
Albany Medical College, Albany, NY.
Objectives: To critically evaluate imaging of tibial artery
run-off in patients who underwent initial angiography using carbon
dioxide and subsequently Gadodiamide as contrast.
Methods: When use of iodinated contrast is contraindicated,
Gadodiamide contrast has been used in our institution to salvage
tibial artery run-off when a carbon dioxide angiogram has been
sub-optimal to evaluate this region. To critically evaluate this
technique, all angiograms performed in this manner, with identical
projections, were reviewed. Images were acquired in three identical
Philips Integris V3000 angiography suites, where optimal imaging
technique was used for the specific contrast agent. A retrospective,
blinded evaluation of the carbon dioxide and Gadodiamide tibial
artery angiograms was performed by means of a questionnaire
administered to the vascular radiologists and vascular surgeons.
Data were evaluated using a one-sided McNemar test where the
responses were grouped in a binary fashion.
Results: Fourteen tibial artery angiograms of six patients
were reviewed by twelve observers (seven vascular surgeons, five
vascular radiologists). There was significantly increased
confidence, on the Gadodiamide angiograms, in deciding which tibial
artery to bypass to (p<0.0001) and where on the selected tibial
artery to place the distal anastomosis of the bypass ((p<0.0001).
The observers felt that the overall diagnostic yield was
significantly better for the Gadodiamide angiograms compared with the
carbon dioxide angiograms (p<0.0001) and that Gadodiamide more
closely approximated images obtained using iodinated contrast
(p<0.0001).
Conclusion: The use of Gadodiamide contrast to salvage carbon
dioxide angiograms of the tibial arteries appears to significantly
improve the diagnostic yield of the study and aid in the pre-surgical
planning of infrapopliteal bypasses.
