Has arteriography gotten a bad name? Current accuracy and morbidity of diagnostic contrast arteriography for aortoiliac and lower extremity arterial disease

Recently, contrast arteriography has been challenged as the diagnostic test of choice for lower extremity arterial disease because of its associated m orbidity and questionable accuracy in identifying suitable distal outflow a rteries. The purpose of this report was to analyze our experience to determ ine if these concerns were justified. We reviewed 500 consecutive contrast arteriograms performed at our hospital for aortoiliac and lower extremity a rterial disease between November 1994 and November 1998. Arteriograms perfo rmed in conjunction with therapeutic procedures such as balloon angioplasty , stent placement, and thrombolysis were excluded, leaving 244 diagnostic c ases for analysis. Forty-six percent (112) of patients had diabetes mellitu s, 14% (34) had an elevated baseline serum creatinine (greater than or equa l to1.5 mg/dL), and an additional 7% (17) were dialysis dependent. Radiolog ists limited contrast volume by imaging only the symptomatic extremity when appropriate and using digital subtraction techniques as indicated. Our res ults showed that diagnostic contrast arteriography is associated with an ac ceptably low morbidity, has an accuracy that is unlikely to be surpassed by other modalities, and remains the diagnostic test of choice for lower extr emity arterial disease.