Search

500 patients were studied respectively for complications of intravenous digital subtraction angiography (IV-DSA) performed with non-ionic contrast media, using a central venous injection technique. In 21 patients (4.2%) during or shortly after the procedure 23 systemic, 1 neurologic, and 7 local complications occurred. In addition 1 patient developed acute renal failure 26 hours after the IV-DSA, whereas 4 patients later showed on thromboses of the catheterised vein. No permanent neurologic or systemic complications and severe allergic reactions were seen.

The probability to induce leukemia or malignoma by roentgenexamination of the gastrointestinal tract is quite small. Basing on riskestimations of the ICRP and own measurements, the probability is about 1:25,000 in angiography. For x-ray examination of the stomach-duodenum, the small bowl, and the colon the radiation risk is approximatively 1:300,000 to 1:800,000. The probability to provoque radiation induced mutations, manifesting themselves in future children or grandchildren, is quite similair for male patients. On the other hand the risk for future children and grandchildren of female patients is a bit higher. An exception is the roentgenexamination of the colon, because direct exposure of the testes is in general inevitable.

During the last 20 years there was an essential improvement in the tolerance of intravasal contrast media, leading to the nonionic low osmotic contrast media. In 26 consecutive patients with different stages of coronary heart disease the nonionic low osmolar contrast media iopamidol (Solutrast) and iopromide (Ultravist) were tested during coronary artery and left ventricular angiography. In both contrast media there were practically identically only slight early haemodynamic reactions with a decrease of heart rate, systolic pressure in the left ventricle, pressure in the aorta and an increase in pressure in the pulmonary artery and partly in cardiac output. These reactions are probably due to higher osmolality in comparison with blood. Therefore, further development of isotonic contrast media would be necessary.

Own observations and the review of the literature show that complications of arteriography may appear after some hours or some days. The causal context is given in general for complications that may be due to the puncture. This is valid, too, for renal insufficiency induced by contrast substance. Neurological symptoms appearing hours or days after cerebral angiography are more difficult to evaluate. Different influences may contribute. The information of the patient before arteriography may in some cases include complications of possible follow-up treatment.

Two groups of patients (A = 19 less than 50 a; B = 21 greater than 50 a) were supervised during coronary injection as to cardiac and pulmonary pressure. In both groups there is an equivalent increase of the cardiac index by 20%, the initial value being lower in groups B. The increase lasts for more than 2 Min. During 5 Min the pulmonary pressure is increased by 25%. The reaction is based on an intracellular calcium flow induced by contrast medium.

Hematemesis in a thorotrastosis patient with severe liver dystrophy led to a tentative diagnosis of portal hypertension. The possibility of portal hypertension was eliminated via angiography. The cause of the hematoemesis was multiple bleeding stomach ulcers. In spite of severe damage to the liver parenchyma, portal hypertension with thorotrastosis does not usually occur. This has been confirmed in the literature and by histologic investigations. In second thorotrastosis patient, the cause of pain and swelling was a sterile abscess formation in the area of the thorotrastoma.

Esophago-tracheal fistulae develop to an increasing extent due to the long-term intubation in intensive-care patients. Their treatment is usually problematic, since the general condition of the patient, weakened by his basic disease, very often does not permit any major intervention; in addition, the topographical location of the fistula makes the access to it even more difficult. In one patient two attempts failed to close the fistula from an extended tracheostomy. The narrow access passage between the anaesthetic tube and the tracheal wall did not permit an exact suture; the heavy formation of scars in the fistular environment did not permit either a preparation in layers or the shift of mucosal flaps for coverage. However, a fistula was successfully closed from a collar mediastinotomy. With normal tracheal width, unrestricted esophagus function was restored without damage to the recurrent laryngeal nerve. The advantages of this surgical method are discussed in greater detail.

Within the framework of a clinical study, subjective and objective data were compiled on the low-osmolar contrast medium ioxaglinic acid. In 213 angiographies performed on 134 patients in the Department of Radiology I of the Ulm University Clinic from October 1979 to February 1980, it was established that unfavourable subjective symptoms were missing to a major extent. Hence, we believe that it is not justified to subject the patients to the additional stress of general narcosis when performing peripheral and cerebral angiographies. In more than 50% of the patients, the contrast medium produced either an increase or a drop in blood pressure; a state of collapse requiring treatment never occurred in any of the patients.

Coronary angiography is a radiologic special technique with its place in the diagnosis of coronary disease. It demands much equipment and time. Evaluation, particularly in coronary sclerosis, is valuable, since it makes subtile differential diagnosis possible. This in turn is the basis for modern individual therapy.

A patient is presented in whom multiple lienal circular foci are seen 25 years after application of a thorium-containing contrast medium for vascular visualization, over and above the well-known characteristic ThO2 deposits in the liver and spleen. The article discusses the problem whether these circular foci which meet the angiographic criteria of an angioblastic sarcoma, should be considered as a thiorium-induced neoplasia.

During 73 cardiac angiographies and 10 angiograms of the abdomen and extremities, the x-ray doses were determined at the arm and forehead (eyes) of the radiologists and assistant staff. The results are discussed and compared with the recommendations of the ICRP and valid legislation. It is recommended to use an additional dosimeter at the forehead if higher frequencies are employed.

Acute aortic thrombosis is a rarely described complication of angiography with the technique of arterial catheterization. In the presented case record, a sudden therapy-resistant rise in blood pressure was accompanied by paraplegia of the lower limbs. The activation of the coagulation system caused by the heterogeneous material brought into the aorta, combined with severe arteriosclerosis, is discussed as a possible cause.

This is a report on a perforation of the myocardium during pulmonary angiography. The choice of the catheter is very important for the occurrence of such complications. We used a Cook 7 French polyethylene multipurpose catheter, which did not guarantee sufficient stabilisation due to its small number of side holes during injection of contrast medium. On the other hand the straight top of the catheter promoted its penetration into the myocardium. To avoid such often lethal complications, catheters with pigtail configuration should be used.

Coronary- and LV-angiography in coronary heart disease are indicated I) to clarify whether or not surgery is required (e.g. aorto-coronary-bypass operation, aneurysmectomy) in 1) drug resistent angina pectoris, 2) myocardial aneurysms (or the suspicion of), 3) VSD following myocardial infarction and/or 4) as preoperative investigations in mitral regurgitation or 5) other valve lesions. II) These investigations are furthermore indicated in the under-50-yr.-old considering their prognosis and diagnosis 1) following myocardial infarction 2) to clarify a pathological exercise test with or without angina pectoris 3) in the differential diagnosis of myocardial diseases and 4) occasionally in patients with a number of risk factors or exposed to particular occupational hazards or from families with a high incidence of early deaths from heart disease. Coronary- and LV-angiography are contraindicated in 1) generalized stenosing atherosclerosis, 2) acute myocardial infarction, 3) failure from other organ-systems (e.g. kidney), 4) drug resistent endogenous risk factors and/or relevant obesity, 5) biological age over 60-65.6) continued nicotine dependence. In many cases the specific diagnostic investigations will include the assessment of coronary flow at rest and during maximal drug induced coronary dilatation. This enables us to estimate the coronary reserve and to diagnose coronary insufficiency in patients with normal coronary angiograms.- Instructive morphological and/or functional results illustrate this presentation.

Thorium dioxide (Thorotrast) was used as a contrast medium from 1930 to 1945. It gave excellent contrast and was well tolerated during the application, but due to its radioactivity and its long biological half life it caused various late complications as fibrosis and malignant tumors. The late side effects of the substance are reported on, and the most frequent complication--the induction of hepatomas--is illustrated by two cases.