Radionuclide angiography in the evaluation of arterial and venous grafts.

Isotope angiography has proven to be a safe, rapid, accurate, economical, and essentially painless minimally invasive technique for the evaluation of the integrity of native and transplanted vessels. It may be used as a screening procedure for preoperative evaluation of the major vascular tree and for periodic reevaluation of the continuing patency of native and transplanted vessels.

Preliminary clinical experience with the use of absorbable mesh splenorrhaphy.

Splenorrhaphy was performed in six patients using absorbable polyglycolic acid mesh. The sustained injuries included blunt and penetrating trauma and varied from through-and-through puncture with hematoma and deep lacerations to amputation of a portion of the spleen. A number of different splenorrhaphy techniques were required. In all six cases, the procedure was accomplished without abscess formation, postoperative bleeding, or complications related to the use of the mesh.

Radionuclide evaluation of peripheral vascular injuries.

Radionuclide techniques have become an important modality for the detection and evaluation of peripheral vascular trauma. The presence of significant vascular injury can be diagnosed using essentially noninvasive procedures. A normal radionuclide angiogram reliably indicates the absence of injury to the major peripheral arterial vessels. An abnormal study suggests that further diagnostic maneuvers may be indicated.

Scintiangiographic demonstration of bleeding into a wrist ganglion.

Scintiangiography with delayed static scintiphotos may be used to demonstrate bleeding. Bleeding into a traumatic ganglion of the wrist was demonstrated by this technique following failure of conventional contrast arteriography. Scintiangiography with delayed scintiphotography is now performed in any case in which bleeding is suspected.

The value of scintiangiography in arterial disease.

Arterial visualization using the gamma camera was achieved by peripheral intravenous injection of technetium pertechnetate Tc 99m 253 times in 200 patients. This technique, which successfully images the arterial tree to the level of the wrist and ankle, was validated by blind comparison of the scintiangiograms with contrast arteriograms or surgical findings or both in 93 studies. Although scintiangiography has less resolution than contrast arteriography, it provides quantitative and other important supplementary information in the diagnosis and management of patients with arterial disease. Scintiangiography has accurately diagnosed arterial occlusions (atherosclerotic, traumatic, and embolic), true and false aneurysms, and arterial stenoses. Patients sustaining trauma to the extremities may be evaluated by scintiangiography as a screening technique. Postoperatively, scintiangiography has replaced contrast arteriography for assessing patency of grafts and completeness of thromboembolectomy and for the long-term follow-up of these patients.

Isotope angiography: technique, validation and value in the assessment of arterial reconstruction.

Isotope angiography performed by intravenous injection of technetium 99m pertechnetate has been demonstrated to be of value in the diagnosis and management of a variety of disorders of the large arteries. An improved technique of isotope angiography is described and the technique validated (53 cases) in normal and diseased arteries by correlating it with conventional contrast arteriography and/or operative findings. Peripheral arteries as far distal as the wrist or mid-calf have been accurately visualized and quantitation of isotope arrival times and total isotope activity in different parts of the arterial tree has provided a means of evaluating the hemodynamic significance of stenosing lesions. Thirty-nine arterial reconstructions were studied by this technique. Seven of 27 (26%) clinically patent arterial reconstructions were found to be harboring significant and potentially dangerous imperfections which were clinically unsuspected. Nine of 12 (75%) arterial reconstructions thought clinically to be occluded were demonstrated to be patent, obviating the need for invasive contrast arteriography. Isotope angiography may be used with no risk for the immediate postoperative and long-term evaluation of arterial reconstructions. Only those patients with abnormalities identified on isotope angiography need have conventional contrast arteriography for further delineation of the abnormality so that it may be repaired before it causes failure of the reconstruction.

Isotope angiograpy for detection of embolic arterial occlusion.

Radionuclide angiography is a safe, noninvasive, easily performed and rapidly executed technique which will accurately demonstrate the presence of an acute occlusion of the arterial tree of the lower extremities. The diagnosis of embolic or thrombotic occlusion of the arterial circulation of the lower extremity in the critically ill patient often is not clear. Visualization of the arterial tree prior to any operation is advantageous, but these patients are invariably in such poor general physical condition that one wound prefer not to submit them to the invasive and time-consuming procedure of conventional contrast arteriography. Radionuclide angiography was performed in three patients who had an equivocal diagnosis of acute occlusion of the femoral artery. Acute occlusion was correctly diagnosed by this technique in all three patients.