Comparison of the efficacy of digital subtraction and film-screen angiography of the lower limb: prospective study in 50 patients

Abstract

We prospectively compared current digital subtraction angiography (DSA) with conventional film-screen angiography (FSA) of the lower limb for evaluation of areas of arterial stenosis and degree of arterial visualization. Fifty patients had both DSA and FSA of a single lower limb. Specific anatomic sites (examiner-selected sites) throughout the lower limb were marked on each film by an experienced angiographer (examiner). These sites consisted of the common femoral, superficial femoral, popliteal, anterior tibial, posterior tibial, peroneal, and dorsalis pedis arteries and bypass grafts, when present. The films were then reviewed blindly by two different experienced angiographers (observers). All sites were graded for the degree of arterial narrowing based on a standard scale (grade 1 = normal, grade 5 = occluded) that also included grading for nonvisualization (grade 6). Each observer also selected the most stenotic site in each anatomic area (observer-selected sites). The data were analyzed for the entire lower limb and at specific anatomic sites. DSA sites were judged to be slightly more narrowed (p less than .05) in the superficial femoral artery by both observers and in the common femoral artery, bypass graft, and overall by a single observer. No other significant differences were found in grade of stenosis or vessel visualization for examiner-selected sites. For observer-selected sites, observers agreed on the location of the most stenotic site 76% of the time for FSA and 69% of the time for DSA. No significant difference was found in grade of stenosis or vessel visualization for either observer for the entire lower limb or at specific anatomic sites. These findings were present when all sites chosen were considered and when there was agreement between sites chosen on FSA and DSA for each observer. In conclusion, optimal-quality FSA and DSA produced virtually equivalent results for angiography of the lower limb for both grade of stenosis/occlusion and vessel visualization.