Evaluation of intraoperative arteriography as a routine for vascular reconstructions

A retrospective analysis of 391 intraoperative arteriograms performed after reconstruction operations on the carotid, aorta and lower extremity vasculature showed the value of incorporating this procedure as a routine only for the last mentioned site. Identification and correction of inadequacies due to technique are possible. Revisions in technique based upon these experiences have significantly diminished their incidence. Routine intraoperative arteriography for revascularization procedures of the lower extremity has further enabled us to classify reliably the runoff and correlate these findings with subsequent graft patency. Late graft closure, predominantly due to progressive or accelerated obliterating atherosclerosis in the distal circulation, occurred almost exclusively within the first year following reconstruction in those patients identified as having poor runoff by intraoperative arteriography. This group, in particular, should be closely monitored by noninvasive physiologic means and even postoperative arteriography to enable either prophylactic or therapeutic correction. In some instances, based upon intraoperative arteriography or subsequent studies, fruitless and potentially harmful reoperative vascular procedures may be obviated.