Advertisement

Digital Subtraction Angiography

  • Leonardo A. Campos
  • Ryan C. SchenningEmail author
Chapter

Abstract

Despite the continued refinement of vascular ultrasound and noninvasive cross-sectional imaging studies (computed tomography angiography [CTA] and magnetic resonance angiography [MRA]) in the diagnosis of vascular pathologies, digital subtraction angiography (DSA) remains the “workhorse” imaging modality for the diagnosis and management of peripheral arterial disease. Despite its inherent invasiveness, catheter-based DSA provides excellent spatial resolution of vascular pathology in a time-resolved fashion, allowing for detailed anatomic assessments and direct visualization of “flow” within a given vessel. The ability of DSA studies to capture high-resolution anatomic and physiologic information within relatively large two-dimensional anatomic fields of view (FOV) provides the basis for DSA being considered the “gold standard” diagnostic imaging modality for many vascular pathologies.

Additionally, in the nearly six decades since Charles Dotter performed the first percutaneous transluminal angioplasty, the development of image-guided catheter-based interventions has revolutionized medicine and spawned the advent of the following specialties: interventional radiology, neurointerventional surgery, interventional cardiology, and endovascular surgery. DSA, along with intra-procedural fluoroscopic guidance, is the imaging modality that allows these catheter-based interventional specialties to see, diagnose, and treat an ever-expanding number of vascular and nonvascular pathologies. To adequately intervene, however, a solid foundation in DSA “basics” is of paramount importance.

Keywords

Digital subtraction angiography DSA Peripheral arterial disease Vascular diagnosis 

References

  1. 1.
    Dotter CT, Judkins MP. Percutaneous transluminal treatment of arteriosclerotic obstruction. Radiology. 1965;84:631–43. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/14275329.  https://doi.org/10.1148/84.4.631.CrossRefPubMedGoogle Scholar
  2. 2.
    Kotecha R, Toledo-Pereyra LH. Beyond the radiograph: radiological advances in surgery. J Investig Surg. 2011;24(5):195–8. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21867387.  https://doi.org/10.3109/02713683.2011.615210.CrossRefGoogle Scholar
  3. 3.
    Mistretta CA, Crummy AB, Strother CM. Digital angiography: a perspective. Radiology. 1981;139(2):273–6. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/7012918.  https://doi.org/10.1148/radiology.139.2.7012918.CrossRefPubMedGoogle Scholar
  4. 4.
    Wilkins RH, Moniz E. Neurosurgical classic. Xvi. Arterial encephalography. Its importance in the localization of cerebral tumors. J Neurosurg. 1964;21:144–56. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/14113954.  https://doi.org/10.3171/jns.1964.21.2.0144.CrossRefPubMedGoogle Scholar
  5. 5.
    Cowen AR. Cardiovascular X-ray imaging: physics, equipment and techniques. In: Catheter-based cardiovascular interventions: a knowledge-based approach. Berlin: Springer; 2013. p. 203–59.Google Scholar
  6. 6.
    Seldinger SI. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta Radiol. 1953;39(5):368–76.. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/13057644.CrossRefGoogle Scholar
  7. 7.
    Mistretta CA, Crummy AB. Diagnosis of cardiovascular disease by digital subtraction angiography. Science. 1981;214(4522):761–5.CrossRefGoogle Scholar
  8. 8.
    Crummy AB, Stieghorst MF, Turski PA, Strother CM, Lieberman RP, Sackett JF, et al. Digital subtraction angiography: current status and use of intra-arterial injection. Radiology. 1982;145(2):303–7. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/6753013.  https://doi.org/10.1148/radiology.145.2.6753013.CrossRefPubMedGoogle Scholar
  9. 9.
    Bakal CW. Advances in imaging technology and the growth of vascular and interventional radiology: a brief history. J Vasc Interv Radiol. 2003;14(7):855–60.  https://doi.org/10.1097/01.rvi.0000082831.75926.22.CrossRefPubMedGoogle Scholar
  10. 10.
    Harrington DP, Boxt LM, Murray PD. Digital subtraction angiography: overview of technical principles. AJR Am J Roentgenol. 1982;139(4):781–6. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/6751053.  https://doi.org/10.2214/ajr.139.4.781.CrossRefPubMedGoogle Scholar
  11. 11.
    Cowen AR, Davies AG, Sivananthan MU. The design and imaging characteristics of dynamic, solid-state, flat-panel x-ray image detectors for digital fluoroscopy and fluorography. Clin Radiol. 2008;63(10):1073–85. Retrieved from https://www.scopus.com/inward/record.uri?eid=2-s2.0-50949110251&doi=10.1016%2fj.crad.2008.06.002&partnerID=40&md5=9710c4f382265e2482f3fdd617d96b8c.  https://doi.org/10.1016/j.crad.2008.06.002.CrossRefPubMedGoogle Scholar
  12. 12.
    Turski PA, Stieghorst MF, Strother CM, Crummy AB, Lieberman RP, Mistretta CA. Digital subtraction angiography “road map”. AJR Am J Roentgenol. 1982;139(6):1233–4. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/6983278.  https://doi.org/10.2214/ajr.139.6.1233.CrossRefPubMedGoogle Scholar
  13. 13.
    Pooley RA, McKinney JM, Miller DA. The AAPM/RSNA physics tutorial for residents: digital fluoroscopy. Radiographics. 2001;21(2):521–34. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11259716.  https://doi.org/10.1148/radiographics.21.2.g01mr20521.CrossRefPubMedGoogle Scholar
  14. 14.
    Oppenheimer J, Ray CE Jr, Kondo KL. Miscellaneous pharmaceutical agents in interventional radiology. Semin Interv Radiol. 2010;27(4):422–30. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22550384.  https://doi.org/10.1055/s-0030-1267854.CrossRefGoogle Scholar
  15. 15.
    Kerns SR, Hawkins IF Jr. Carbon dioxide digital subtraction angiography: expanding applications and technical evolution. AJR Am J Roentgenol. 1995;164(3):735–41. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/7863904.  https://doi.org/10.2214/ajr.164.3.7863904.CrossRefPubMedGoogle Scholar
  16. 16.
    Sharafuddin MJ, Marjan AE. Current status of carbon dioxide angiography. J Vasc Surg. 2017;66(2):618–37. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28735955.  https://doi.org/10.1016/j.jvs.2017.03.446.CrossRefPubMedGoogle Scholar
  17. 17.
    Daftari Besheli L, Aran S, Shaqdan K, Kay J, Abujudeh H. Current status of nephrogenic systemic fibrosis. Clin Radiol. 2014;69(7):661–8. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24582176.  https://doi.org/10.1016/j.crad.2014.01.003.CrossRefPubMedGoogle Scholar
  18. 18.
    ACR Committee on Drugs and Contrast Media. Patient Selection and Preparation Strategies Before Contrast Medium Administration. ACR Manual on Contrast Media V10.3. 2018. p. 5–13.Google Scholar
  19. 19.
    Kaufman JA, Lee MJ. Vascular and interventional radiology: the requisites. Philadelphia: Elsevier; 2014.Google Scholar
  20. 20.
    Osiro S, Zurada A, Gielecki J, Shoja MM, Tubbs RS, Loukas M. A review of subclavian steal syndrome with clinical correlation. Med Sci Monit. 2012;18(5):RA57–63.. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22534720.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of RadiologyBoston University School of Medicine, Boston Medical CenterBostonUSA
  2. 2.Charles T. Dotter Department of Interventional Radiology, Dotter Interventional InstituteOregon Health & Science UniversityPortlandUSA

Personalised recommendations