Renal Cancer: Translumbar Arteriography for Its Recognition

In 1949, when we embarked upon our first studies of translumbar arteriography, the prevailing thought in this country regarding needle puncture of the aorta in human subjects was not favorable, and we approached the problem with a certain anxiety. This was in sharp contrast to European surgeons, who had shown little hesitancy in utilizing this technic, the essential safety of which (when properly carried out) had been widely accepted. In Europe today, despite reports of isolated accidents and undesirable side-effects, arteriography is taken for granted, being performed as routinely as pyelographic studies in our own hospitals. In the United States, on the other hand, passage of almost a decade since my first attempts has brought no universal shift in opinion as to the value and safety of translumbar arteriography in the diagnosis of tumors and cysts of the retroperitoneal space as well as other urological lesions. With the technic originally presented by the writer (1), we have continued to have morbidity of a considerably lesser degree than from retrograde pyelography. We have had no fatalities, which is appreciably more than can be said for the use of antibiotics. Especially surprising is the rejection of arteriography as a diagnostic tool on the grounds that it is of questionable value; it is criticized for producing films that are ambiguous and too dependent upon subjective interpretation. In this respect, I am reminded of what Bazin, the eminent French urologist, remarked a generation ago in defense of a technic new at that time and under fire from its critics. He denied that pyelography made mistakes. Urologists, not the films, were at fault. The facts were there to be read by those who could read correctly. Undeniably, experience counts for something in arteriography, both in the taking of the films and their subsequent interpretation. We have regularly utilized this procedure on the urological service of the Christ and Cincinnati General Hospitals for the past seven years. The total number of our aortic punctures is now over 2,500, and we have yet to encounter anything more distressing than minimal morbidity as a result of the procedure (2, 3). To reiterate, we have had no deaths, no known cases of intrarenal arterial thrombosis have occurred, no patient has had a resultant paralysis or other evidence of nerve damage, nor have we had any complications within the intestinal arterial tree. Hemorrhage from the puncture site has never been noted to produce more than transient pain (4). As a physician, I have a responsibility to my patients and I do not expect to expose them to serious or lasting trauma. Further, if a patient is not an acceptable risk for arteriographic study by our technic, he is not usually acceptable for renal exploration. We did not lightly enter upon the practice of this diagnostic aid.