Digital distal lower limb angiography: comparison of selective iliac injection with vasodilators and bolus chasing technique

From October 1992 to May 1993 we carried out a prospective study on 30 patients, mean age 70 years, suffering from lower limb ischaemia (mild,n = 12; moderate,n = 9; severe,n = 9). Four masked investigators compared the outcome of two techniques for the preoperative evaluation of distal vessels of the lower limbs. The reference technique was digital subtraction angiography (DSA) with selective iliac injection, fixed centring on one ankle, and use so vasodilators. The new method was DSA with the so-called bolus chasing technique: after an injection above the aortic bifurcation, an acquisition during a continuous longitudinal translation movement allows all the arteries of the lower limbs to be visualised down to the most distal point. Both techniques are well tolerated and we found no significant difference in the number of distal arteries seen with the two methods. To assess the permeability of the distal lower limb network, the bolus tracking technique is as informative as an iliac selective injection, without its constraints. Consequently, we will routinely use it as the technique of choice.