Use of IV Radionuclide Total Body Arteriography To Evaluate Arterial Bypass Shunts—A New Method— A Review of Several Cases

Abstract

Currently, Doppler ultrasound and contrast angiography are the main imaging procedues being used to evaluate arterial bypass shunts. IV radionuclide total body arteriogra phy (TBA) is another useful imaging procedure for evaluation of bypass shunts. The authors reviewed 33 patients, 19 women and 14 men, ranging in age from forty-three to eighty-five, who had TBA done after arterial bypass surgery. Ten patients had multiple shunts and 5 had multiple follow-up studies. In total there were 80 shunts, including 43 femoropopliteal, 16 axil lofemoral, 1 axillopopliteal, 13 cross over femorofemoral, and 7 aortofe moral shunts. Sixty-two of the 80 shunts were patent, 14 were oc cluded, and 4 had partial occlusion. The results were confirmed by Dop per studies, contrast angiograms, an d/or surgical exploration without false positives or false negatives. Since the radiotracer used was 99mTc labeled red blood cells, a MUGA study can also be performed immedi ately following TBA in the same in jection. Twenty-eight patients had gated cardiac blood pool studies (MUGA) done; 16 had abnormal wall motion and diminished ventricular function. TBA requires only a single IV in jection of radiotracer (less than 1 cc) in the upper limb. The imaging times for total body arterial and perfusion images are seventy seconds and five minutes respectively. Both total body arterial and per fusion images clearly demonstrated the entire course of shunts (single or multiple); underlying and coexisting arterial abnormalities, e g, occlusive disease (27 patients), or aneurysm (3 patients); and related perfusion changes in the extremities. TBA has unique features. It permits a com plete, excellent visualization of the bypass graft without the hazard of contrast media injection. It is a sim ple and a virtually noninvasive proce dure, particularly useful for preoperative workups and post operative follow-ups.