The Value of Arteriography

ROENTGENOLOGIC visualization of the arteries of living subjects by means of intra-arterial injection of opaque substances is relatively new. According to Edwards, who has reviewed the subject, the procedure was first carried out in 1923. The method has never gained wide use, probably because of the difficulty in securing thoroughly satisfactory mediums for injection. The ideal arteriographic medium is one which has high radiopacity, does not cause pain when injected, is freely miscible with blood, and has no toxic effect on blood, blood vessels, or on other organs or systems of the body. A variety of substances have been used; iodides and bromides of sodium, strontium, potassium and calcium, proteinated silver salts, iodized oil, skiodan, diodrast, neoiopax, emulsified lipiodol, and thorium dioxide sol (8). Of these, thorium dioxide sol has the greatest opacity and, in our experience, using 8 to 10 C.C., has no obvious and immediate injurious effect on the blood, blood vessels, or on the body as a whole. The possibility of latent radio-activity has been widely discussed (1, 8, 9). Unfortunately, however, this property of thorium dioxide sol has not been sufficiently considered in the literature, in relation to the amount of the substance used. In experimental work, from 1 to 5 c.c. for each kilogram of body weight has been used. In clinical work, for visualization of the liver and spleen, about 1 c.c. for each kilogram of body weight is necessary. In roentgenologic visualization of arteries and veins of the upper extremities, about 0.10 c.c. for each kilogram of body weight is sufficient. Ericksen and Rigler, who have made an extensive study of the possibility of harmful radio-active effects from the use of thorium dioxide sol, consider that even a greater amount than that just mentioned is distinctly harmless. Our experience in arteriography has been limited largely to the use of thorium dioxide sol; however, we have found that neoiopax, skiodan, and diodrast are deficient in radiopacity and produce pain when injected into an artery. The problem of finding an ideal arteriographic medium has not been solved, and further investigations are being carried out. In the past eighteen months we have used arteriography to examine the peripheral vessels in 85 cases. The following conditions were studied: thrombo-angiitis obliterans (3, 4, 5, 7), arteriosclerosis (5), congenital arteriovenous fistula (10), aneurysm of the popliteal artery (6), arthritis, scleroderma, Raynaud's disease, and hypertension. In some cases in which a search was being made for suspected disease normal blood vessels (2) were found (Fig. 1). In addition to peripheral arteries, visualization of the cerebral arteries (11, 12), and of the abdominal aorta has been reported (13). Our studies have been limited largely to the upper extremities, chiefly because only small amounts of thorium dioxide sol are required for good visualization.