Assessment of Preclinical Organ Damage in Hypertension by Enrico Agabiti Rosei & Giuseppe Mancia

Author:Enrico Agabiti Rosei & Giuseppe Mancia
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

9.9 Digital Subtraction Angiography (DSA)

Angiography is the golden standard for the assessment of PAD but is inappropriate for the evaluation of aneurysms since it outlines only the arterial lumen and is insensitive to the aneurysm diameter, especially if the aneurysm is partially affected by thrombosis or the wall is not heavily calcified. DSA was used in the past to complete the preoperative diagnosis of aortic aneurysms concerning the concomitant presence of PAD in the access vessels and aortic branches, to exclude anatomic variations before open surgical repair or to assist in length measurement before EVAR. This has become obsolete with the advent of 3-D dedicated workstations with rapid and detailed volume rendering of CT and MR imaging [85, 86].

Angiography is therefore currently used during endovascular therapeutic procedures. DSA usually requires iodine intra-arterial contrast. This is nephrotoxic as discussed above and modern angiographic equipment allow radiation adjustments in order to be able to limit the amount of contrast used [87]. Moreover, carbon dioxide can also be used as a contrast medium but has limited application when imaging arteries with dorsal origin and should be avoided above the diaphragm [88, 89].

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