Digital subtraction angiography as a method of screening for coronary artery disease during peripheral vascular angiography.

Since myocardial infarction is the major cause of perioperative and postoperative death following peripheral vascular surgery, an accurate method of screening for coronary artery disease in this group of patients is needed. Digital subtraction angiography (DSA) with the use of intra-arterial aortic root injection of contrast material was evaluated as a method of screening for coronary artery disease in patients undergoing angiography for peripheral vascular disease. The feasibility of this method was demonstrated in animal experiments. Fifteen milliliters of Renografin-76 was power injected into the aortic root of seven anesthetized 20 kg mongrel dogs. Normal coronary artery anatomy was clearly demonstrated with DSA, and a series of iatrogenically created stenoses and occlusions were accurately identified. Excellent definition of patent grafts to the left anterior descending and circumflex coronary arteries was obtained in two dogs that had undergone previous coronary artery bypass grafting. A balloon occluder on one graft was used to demonstrate partial and near-total obstruction of the bypass graft. We are currently studying the use of aortic root injections using DSA to determine coronary artery disease in patients having standard angiography for peripheral vascular disease. Adequate visualization of coronary arteries and bypass grafts with only 20 ml of contrast has been obtained. The potential ability of this technique to identify and allow treatment of life-threatening coronary artery lesions in patients prior to or simultaneously with peripheral vascular surgery may result in reduced mortality.