The value of digital subtraction angiography for the demonstration of an extra-anatomic bypass

DSA is a well-established diagnostic procedure. A special indication and technique was employed in the application of DSA, using a low-dose contrast medium in 11 patients with extra-anatomic arterial reconstructions (3 axillofemoral, 4 femoro-femoral suprapubic cross-over bypasses, 4 obturator bypasses). This approach has not been previously described in literature. The authors performed direct puncture of the very proximal part of the bypass with a small (0.6 mm) ''subcutaneous'' neddle. Less than 2 ml of contrast medium was applied, and DSA was accomplished in several positions. In 11 patients high-quality imaging of the entire extra-anatomic bypass was achieved. Advantages of the procedure are: 1. Minimal dose of contrast medium (1-2 ml.). 2. Possibility of angiography even during anticoagulant therapy. 3. Complete imaging of extended bypass procedures with minimal discomfort to high-risk patients. (orig.)