Exit Angiography

Abstract

Very few physicians would disagree that it is in the best interest of a patient to leave the operating room with a good surgical result. Significant residual pathology complicates postoperative recovery, and the outcome of patients requiring cardiac catheterization after cardiac surgery prior to hospital discharge is poor. Asoh and colleagues reported on the outcome of 49 children who underwent 62 cardiac catheterization procedures after cardiothoracic surgery prior to hospital discharge and found a need for catheter interventions in 56 % and surgical reoperation in 37 %, with an overall mortality of 43 % [1]. With this data, identifying and preemptively treating residual structural pathology reduces postoperative hemodynamic compromise and is clearly preferable to rescue interventions. Yet, despite those very convincing arguments for completion (exit) angiography after cardiothoracic surgery, the technique is only selectively used in most centers. While there are many reports of using exit angiography in peripheral vascular interventions, coronary artery bypass grafting, as well as carotid endarterectomy (TEA) [2–5], only very few reports exist on the findings and clinical implications of exit angiography [6, 7]. This is in sharp contrast to transesophageal echocardiography which has become a standard intraoperative diagnostic tool with data having documented a significant impact through the use of routine perioperative transesophageal echocardiography [8]. However, while transesophageal echocardiography is an excellent tool for assessing intracardiac anatomy and ventricular function, its use is much more limited for the evaluation of extra cardiac vascular structure. This is where completion angiography has distinct advantages, and this chapter will outline some of the technical considerations as well as discussing patient selection and outcomes of completion angiography.