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Translumbar renal aortography
Progress
Notes in Cardiology
Edited by EMANUEL GOLDBERGER, M.D., P.A.C.C. New York,
New York
Translumbar
Renal Aortography In the study of the lower abdominal aorta, translumbar aortography is of considerable value because it not only helps to determine aneurysmal change or the degree of patency of the arteriosclerotic vessel, but also aids the surgeon in deciding on the proper surgical management, if operation is indicated. The care and experience with which the procedure is performed, the amount and type of medium used, the age and condition of the patient, and the premeditation and anesthesia employed influence the incidence and severity of reactions or complications that may be encountered. General precautions, contraindications and treatment of systemic reactions are the same as those for excretory urography. Inherent dangers of aortography include: (1) Renal damage and shutdown. (2) Neurologic complications: These occurred in only 0.22 per cent of the patients in McAfee’s survey (Raditransverse myelitis or ology, 68: 825, 1957); paraplegia were the disturbances noted most frequently, and they appeared to be related at least in part to the amount of contrast medium employed. That is, larger doses are more likely to cause difficulty. (3) Cardiovascular complications such as shock, cardiac arrest, or failure, and coronary occlusion: These occurred in 0.09 per cent of the patients in McAfee’s survey. (4) Hemorrhage from the puncture site. (5) Necrosis of the intestinal wall: This may occur if the medium is accidentally injected into the superior mesenteric artery. (6) Sensitivity to the medium. Temporary reduction of renal function, as measured by clearance of creatinine and paraaminohippuric acid, has been shown to occur in dogs given injections of the radiopaque medium into a renal artery (T. F. Mullady and co-workers: J.A.M.A., 184: 716, 1963). Special caution is advised to avoid inadvertent intrathecal injection.
R. JESSE E. Thompson has recently described a simple technic for translumbar renal aortography, utilizing Polaroid and regular x-ray film, which revealed 40 positive lesions in 35 of 140 hypertensive patients (Radiology News, 2 : 5,1964). There were no major complications. Guided by the patient’s pyelogram, he places a small metal marker on the patient’s back, and its position is then marked with a skin pencil at the approximate location of the renal artery, usually at the first and second lumbar interspace. Next, a Polaroid x-ray film is taken to ascertain the exact location of the first and second lumbar interspace in relation to the skin marks. The aorta is then punctured at this level, and 6 cc. of 50% sodium diatrizoate (Hypaque@), is injected. Another Polaroid film is taken to check the position of the needle. Finally, 20 cc. of the contrast medium is injected, and a regular 14 X 17 x-ray film is exposed. The use of radiopaque agents for visualization of the abdominal aorta and its branches has become a widely accepted procedure. Although other measures may be used to gain information regarding the abdominal arterial system, aortograms are likely to give the most satisfactory and definitive findings. Translumbar aortography (translumbar arteriography), although diagnostically the method of choice, should be used only when more conservative measures are inadequate or have failed. Since the procedure is not without some danger, it should be employed only by persons experienced in the technic. Renal agenesis, duplication or ectopia, and polycystic kidney are among the indications for translumbar arteriography. Pheochromocytoma or other adrenal tumors may be located. This procedure may also be of great value in determining obstruction of the renal artery or one of its branches.
D
JULY 1964
125
Notes in Cardiology
Edited by EMANUEL GOLDBERGER, M.D., P.A.C.C. New York,
New York
Translumbar
Renal Aortography In the study of the lower abdominal aorta, translumbar aortography is of considerable value because it not only helps to determine aneurysmal change or the degree of patency of the arteriosclerotic vessel, but also aids the surgeon in deciding on the proper surgical management, if operation is indicated. The care and experience with which the procedure is performed, the amount and type of medium used, the age and condition of the patient, and the premeditation and anesthesia employed influence the incidence and severity of reactions or complications that may be encountered. General precautions, contraindications and treatment of systemic reactions are the same as those for excretory urography. Inherent dangers of aortography include: (1) Renal damage and shutdown. (2) Neurologic complications: These occurred in only 0.22 per cent of the patients in McAfee’s survey (Raditransverse myelitis or ology, 68: 825, 1957); paraplegia were the disturbances noted most frequently, and they appeared to be related at least in part to the amount of contrast medium employed. That is, larger doses are more likely to cause difficulty. (3) Cardiovascular complications such as shock, cardiac arrest, or failure, and coronary occlusion: These occurred in 0.09 per cent of the patients in McAfee’s survey. (4) Hemorrhage from the puncture site. (5) Necrosis of the intestinal wall: This may occur if the medium is accidentally injected into the superior mesenteric artery. (6) Sensitivity to the medium. Temporary reduction of renal function, as measured by clearance of creatinine and paraaminohippuric acid, has been shown to occur in dogs given injections of the radiopaque medium into a renal artery (T. F. Mullady and co-workers: J.A.M.A., 184: 716, 1963). Special caution is advised to avoid inadvertent intrathecal injection.
R. JESSE E. Thompson has recently described a simple technic for translumbar renal aortography, utilizing Polaroid and regular x-ray film, which revealed 40 positive lesions in 35 of 140 hypertensive patients (Radiology News, 2 : 5,1964). There were no major complications. Guided by the patient’s pyelogram, he places a small metal marker on the patient’s back, and its position is then marked with a skin pencil at the approximate location of the renal artery, usually at the first and second lumbar interspace. Next, a Polaroid x-ray film is taken to ascertain the exact location of the first and second lumbar interspace in relation to the skin marks. The aorta is then punctured at this level, and 6 cc. of 50% sodium diatrizoate (Hypaque@), is injected. Another Polaroid film is taken to check the position of the needle. Finally, 20 cc. of the contrast medium is injected, and a regular 14 X 17 x-ray film is exposed. The use of radiopaque agents for visualization of the abdominal aorta and its branches has become a widely accepted procedure. Although other measures may be used to gain information regarding the abdominal arterial system, aortograms are likely to give the most satisfactory and definitive findings. Translumbar aortography (translumbar arteriography), although diagnostically the method of choice, should be used only when more conservative measures are inadequate or have failed. Since the procedure is not without some danger, it should be employed only by persons experienced in the technic. Renal agenesis, duplication or ectopia, and polycystic kidney are among the indications for translumbar arteriography. Pheochromocytoma or other adrenal tumors may be located. This procedure may also be of great value in determining obstruction of the renal artery or one of its branches.
D
JULY 1964
125