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Evaluation of Aortography in Abdominal Diagnosis

1951; Radiological Society of North America; Volume: 56; Issue: 2 Linguagem: Inglês

10.1148/56.2.183

1527-1315

L. R. Sante,

Cardiac, Anesthesia and Surgical Outcomes

A QUARTER OF A century has elapsed since dos Santos and his associates (1) began their work on injection of the circulation with contrast material to render the vascular structures opaque on x-ray examination. Further work by the same authors in 1931 did much to clarify the procedure (2). Many others have subsequently contributed to the advancement of the method, in respect to technic of injection, types of opaque material injected, and interpretation of the resulting roentgenograms (3–14). Osorio (15), in 1933, confirmed dos Santos' work. Little further was accomplished until Fariñas (16), in 1941, made aortograms after surgically exposing the femoral artery in the groin, inserting a trocar into the vessel, and passing an opaque catheter through the trocar up into the abdominal aorta. The catheter could be readily visualized fluoroscopically and its level noted. In this manner it was possible to inject the circulation of any specific organ with a small amount of 70 per cent diodrast, and both fluoroscopic and roentgenographic observations could be made. Careful scrutiny of Fariñas' original films indicates that this is a valuable method for examination of the aorta and its branches, and in these days of blood vessel surgery it would not be considered too formidable an undertaking. It may have advantages, in some instances, over the blind puncture of the aorta and the rapid injection of sufficient opaque material to fill the entire aortic system at once. Recently the translumbar approach originally used by dos Santos has again come into vogue as a result of a number of improvements which have been introduced. According to Melick and Vitt (17), well over 3,000 cases have been reported without record of a fatality which could be traced to the procedure, though some deaths have occurred a few days later from other causes. Sufficient time has now elapsed for evaluation of the method as an aid in abdominal diagnosis. Within the last two years the translumbar procedure has been subjected to critical analysis and study, especially by Melick and Vitt and by Hartnett (18). Much of the roentgenographic material here presented is from examination of their patients. Practically all technics previously advocated have been considered and tried for evaluation of their simplicity, safety, and effectiveness. Gradual elimination of certain undesirable features and their replacement by more efficient methods have resulted in a smoother, more effective procedure. For instance, difficulty was at first encountered in forcing sufficient opaque solution into the aorta through a narrow-gauge syringe. There is no advantage in using a large-caliber needle if the syringe is of smaller bore.