Pulmonary angiography performed with iopamidol: complications in 1,434 patients.

Hudson, Edwin R.; Smith, Terrence; McDermott, V G; Newman, Glenn E.; Suhocki, Paul V.; Payne, Cynthia S.; Stackhouse, Daniel J.

doi:10.1148/radiology.198.1.8539407

Cited by 97 publications

(43 citation statements)

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“…21,22 The morbidity and mortality rates for this invasive test are reported to range from 3.5% to 6% and 0.2% to 0.5%, respectively. [23][24][25] Use of nuclear medicine imaging, once the first imaging study for suspected PE, is in decline 26,27 because of the high percentage of indeterminate studies (73% of all performed 28 ) and poor interobserver correlation. 29 Revised criteria for the interpretation of ventilation-perfusion examinations 30,31 and novel technologies in nuclear medicine such as SPECT 32 can decrease the proportion of indeterminate scintigraphic studies but cannot offset the limitations inherent to a functional imaging test.…”

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confidence: 99%

Spiral Computed Tomography for Acute Pulmonary Embolism

2004

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There is still considerable debate about the optimal diagnostic imaging modality for acute pulmonary embolism. If imaging is deemed necessary from an initial clinical evaluation such as D-dimer testing, options include nuclear medicine scanning, catheter pulmonary angiography, and spiral CT. In many institutions, spiral CT is becoming established as the first-line imaging test in daily clinical practice. With spiral CT, thrombus is directly visualized, and both mediastinal and parenchymal structures are evaluated, which may provide important alternative or additional diagnoses. However, limitations for the accurate diagnosis of small peripheral emboli, with a reported miss rate of up to 30% with single-slice spiral CT so far, have prevented the unanimous embrace of spiral CT as the new standard of reference for imaging pulmonary embolism. The clinical significance of the detection and treatment of isolated peripheral pulmonary emboli is uncertain. Evidence is accumulating that it is safe practice to withhold anticoagulation in patients with suspected pulmonary embolism on the basis of a negative spiral CT study. Remaining concerns about the accuracy of spiral CT for pulmonary embolism detection may be overcome by the introduction of multidetector-row spiral CT. This widely available technology has improved visualization of peripheral pulmonary arteries and detection of small emboli. The most recent generation of multidetector-row spiral CT scanners appears to outperform competing imaging modalities for the accurate detection of central and peripheral pulmonary embolism. In this review, we assess the current role and future potential of CT in the diagnostic algorithm of acute pulmonary embolism.

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confidence: 99%

Spiral Computed Tomography for Acute Pulmonary Embolism

2004

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“…We did not perform PAG in patients with IPAH and New York Heart Association (NYHA) functional class IV, because the risk of angiography is elevated in such patients. [10][11][12] In our first analysis, we compared the wedged PAG findings prior to the initiation of epoprostenol therapy (24 patients with IPAH) with those after the initiation (mean duration of treatment: 3.9 years, 16 patients with IPAH). In our second analysis, we compared the angiography findings prior to and after initiation of epoprostenol therapy (median duration of treatment: 5.0 years, 9 patients with IPAH) in the same pulmonary arteries in the same subjects (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…Attention is, however, needed when performing PAG in critically ill cases. Studies after 1990 indicate that in less than 1% of cases of acute pulmonary embolism or pulmonary hypertension there were severe complications including respiratory failure and refractory arrhythmia, [10][11][12] and severe complication was related to preexisting critical illness. 10,12 Unsolved Questions About the "Cotton Grass-Like" Stain…”

Section: Safety Of Pag In Pah Patientsmentioning

confidence: 99%

Epoprostenol Infusion Therapy Changes Angiographic Findings of Pulmonary Arteries in Patients With Idiopathic Pulmonary Arterial Hypertension

Sakuma

Demachi²,

Nawata

et al. 2008

Circ J

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ong-term epoprostenol (prostacyclin) therapy improves right-side hemodynamics in patients with idiopathic pulmonary arterial hypertension (IPAH) 1,2 and hence their survival rate. 3,4 The hemodynamic improvement ameliorates the right ventricular free wall metabolism in patients with IPAH. 5 Epoprostenol has a vasodilation effect, inhibits smooth muscle cell proliferation, and has an antiplatelet aggregation effect. 6,7 Prostanoid attenuates the hypertrophy of the pulmonary arteries in rats with monocrotaline-induced pulmonary hypertension. 8,9 The hemodynamic improvement by epoprostenol in humans is thought to also result from changes in pulmonary vessels, but there are no clinical reports to substantiate this hypothesis.Thus, the purpose of this study was to investigate the changes in the angiography findings between 2 time periods: prior to epoprostenol therapy and after chronic use.

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“…[11][12][13] Since 1999 we have routinely performed pulmonary angiography and/or wedged pulmonary angiography in all patients with pulmonary hypertension, except those with New York Heart Association class IV, and have experienced no complications.…”

Section: Pulmonary Angiographymentioning

confidence: 99%

Portopulmonary Hypertension

Sakuma

Souma

Kitamukai

et al. 2005

Circ J

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ortopulmonary hypertension (PPHTN) was previously known as idiopathic pulmonary arterial hypertension (IPAH) with liver injury, but is now established as a clinical entity that is defined as pre-capillary pulmonary hypertension accompanied by hepatic dysfunction and/or portal hypertension. 1 The appearance of PPHTN does not correlate with the severity of the liver dysfunction, 2 and although the cardiac index is relatively preserved, 1,3 there are no reports on the cardiac configuration, pulmonary vascular changes assessed by pulmonary angiography, and plasma levels of brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP), which are indices of loading to the heart. We hypothesized that the changes described would be less prominent in patients with PPHTN, compared with those in IPAH. MethodsOur subjects were 10 patients with PPHTN (2 males, 8 females; mean age 38.5 years, range 22-57) ( Table 1) and 18 patients with IPAH (3 males, 15 females, p=1.00; mean age 38.9 years, range 19-76, p=0.87). The severity of liver failure was classified as A, B or C by Child-Pugh's score. 4 In all subjects, we measured the pulmonary arterial wedge pressure, pulmonary artery pressure, right atrial pressure, aortic pressure, oxygen content in the aorta and pulmonary artery, and cardiac output by routine catheter examination. Fractional pulse pressure was computed as the pulse pressure by the mean pulmonary artery pressure. 5 Additionally, in 8 PPHTN patients and 14 IPAH patients, pulmonary angiography was carried out to examine the configuration of the pulmonary artery tree. Within 1 week after cardiac catheter examination, enhanced electron beam tomography (EBT) (Imatron C-150) was carried out to assess both the ventricular volume and myocardial mass in 5 PPHNT patients and 12 IPAH patients. Electrocardiographic electrodes were attached to each patient's thorax to provide both continuous monitoring of the heart and a trigger signal to the scanner. Patients were placed in a supine position with a 17°axial (feet down) tilt and a 13°slew (to the patient's right) to approximate the short-axis view of the heart. 6-8 A total of 50-60 ml of iopamidol 370 contrast medium was injected into an antecubital vein at a rate of 0.8-1.2 ml/s. The gathering of data was started 40 s after the onset of injection. Ventricular and myocardial volumes were calculated using Simpson's rule from 1-cm slice images (7 mm width and 3 mm gap) in the cine mode (Fig 1). End-diastole was defined according to the timing of the R wave on electrocardiography, and end-systole at the smallest ventricular size. Ventricular volumes were calculated at both end-diastole and end-systole. The left ventricular myocardial volume, including that of the interventricular Background The goal of the present study was to examine the cardiac configuration and pulmonary vascular changes in patients with portopulmonary hypertension (PPHTN) and compare them with those of idiopathic pulmonary arterial hypertension (IPAH). Methods and ResultsThe subjects were 10 patients w...

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Pulmonary angiography performed with iopamidol: complications in 1,434 patients.

Abstract: Pulmonary angiography is a safe procedure, and the margin of safety is enhanced by the use of iopamidol.

Cited by 97 publications

References 0 publications

Spiral Computed Tomography for Acute Pulmonary Embolism

Spiral Computed Tomography for Acute Pulmonary Embolism

Epoprostenol Infusion Therapy Changes Angiographic Findings of Pulmonary Arteries in Patients With Idiopathic Pulmonary Arterial Hypertension

Portopulmonary Hypertension

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