Abdominal aortography.

Abstract

A technic of abdominal aortography has been presented. The procedure is simple, and very little special equipment is necessary. It is relatively harmless, and in our series we have had no fatalities or untoward reactions. Five cases have been presented. In the case of acute aortic occlusion due to a saddle thrombus, we feel that little additional information was obtained by aortography. The procedure in an already desperately ill patient was harmful. In fact, the mere administration of an anesthetic was dangerous. Such cases in nearly all instances are easily recognized, and if seen early enough, aortic embolectomy should be done without loss time. Two cases of aneurysm of the abdominal aorta were presented. One of these was explored and treated, while in the other case, the aortogram revealed that both renal vessels took their origin from the portion of the aorta involved, and the patient was not subjected to surgery which was contraindicated. Aortograms in suspected abdominal aortic aneurysms are of distinct value. Not only do they corroborate the clinical impression, but they also reveal the exact level of the lesion and in most cases its extent as well. Useless exploration is avoided when major branches, such as the renal arteries, are involved. In Figure 4 the aneurysm failed to fill. We do not know whether this was a technical error, but are inclined to believe it was due to abnormal currents in the aneurysm. We hope to gain further knowledge of this type of filling defect as more aneurysms are studied with serial x-rays. In the last two cases presented, we feel that aortography was of decided value. Chronic occlusion of the aortic bifurcation is rare, and although it may be suspected clinically, the exact diagnosis can only be made by aortogram or exploration. Further, the cephalad extension of the thrombosis can be accurately seen. In a case such as the last presented, a partial occlusion can be visualized, and repeated aortography will be of value in studying the progress of the disease. I feel it is worthwhile to mention in closing that in the two cases of chronic aortic occlusion, no large, collaterals to the affected extremities were visualized. However, both of the patients improved following resection of the occluded segments and lumbar sympathectomy. We do not feel that the failure to visualize collateral arterial channels should be a contraindication to the surgical therapy of this disease.