Abdominal Arteriography

The use of a radiopaque medium for visualization of the abdominal aorta and its branches was first described by dos Santos, Lamas, and Caldas (1) in 1929, who reported on 300 cases without a death. In 1936, Henline and Moore (2), apparently questioning dos Santos' statement that blind puncture of the aorta in the paravertebral region was without danger, made an experimental study on dogs. They reported 5 deaths in twenty-one days, as a result of traumatic hemorrhage, and 3 deaths due to toxicity of the substance injected. The controls were poor, however, and the cause of death was indeterminate. Dos Santos properly pointed out that the arterial anatomy and physiology of dog and man are not comparable, and that experimental work on dogs is therefore valueless. Furthermore, Henline and Moore employed a dose approximately equivalent to six times that ordinarily used clinically. This unfavorable report nevertheless delayed the acceptance of the method for many years, until 1941, when Fariñas (3) described catheterization of the aorta (via the femoral artery). In this country translumbar arteriography was first reported by Nelson (4) in 1942, with no serious incidents or sequelae in 73 cases. Melick and Vitt (5), in a review of some 3,000 cases reported up to 1948, could not find a single fatality recorded as directly due to the procedure. Although the technic is exacting, it is fundamentally not a difficult one for qualified personnel. At first the indications were limited, but as experience has accumulated, with encouraging reports, the diagnostic significance and clinical scope are increasingly apparent. Technic of the Procedure The technic of abdominal arteriography as we have been using it, will be outlined. Complete details as to preliminary care, equipment needed, technic of injection, and after-care, have been adequately described elsewhere (6–8). The patient is prepared in the same manner as for intravenous pyelography. Breakfast should be withheld, and appropriate premedication given for sodium pentothal anesthesia. We use no special test for iodine sensitivity, as in all of our patients intravenous pyelograms are part of the routine work-up, before abdominal arteriography is done. This appears to be the most practical test for such sensitivity. We would recommend that retrograde pyelography be combined with the abdominal arteriographic examination whenever possible in the study of renal lesions. We have found this especially valuable for the detection and study of aberrant renal vessels. After arrival in the x-ray department, the patient is placed prone on the x-ray table, with the left side toward the operator. A 14 × 17-inch scout film is made to check positioning and roentgen technic. If the scout film is satisfactory, the patient is then anesthetized with sodium pentothal.