Gangrene Following Intra-Arterial Injection

To the Editor:— I am quite confident that the editorial "Gangrenous Extremities and Intra-Arterial Injection" ( 200 :788, 1967) implied that intra-arterial injections of opaque media used for intravenous pyelography could per se lead to gangrene of an extremity. Proper injections of the radiographic opaque media used in intravenous pyelography and vascular studies are no more likely to result in gangrenous change when injected intra-arterially than when injected intravenously, as radiologists are well able to document. Injuries to arteries associated with catheterization procedures or improper arterial puncture may result in vascular changes leading to disaster. I am confident that the cases referred to in the editorial were ones in which the injections were not intra-arterial but periarterial, leading, thereby, to the sequence of events described. It is highly important that this distinction be recognized. If this were not true, it would be impossible for us to do any arteriographic studies either