PURPOSE: To evaluate image quality, safety, and clinical validity of selective, intraarterial, pulmonary digital subtraction angiography (DSA) with use of a flow-directed, balloon-tipped catheter in patients with suspected acute pulmonary embolism (PE). MATERIALS AND METHODS: Pulmonary DSA was performed in 211 patients with suspected PE. Subselective magnification series were obtained with nonionic contrast material. Clinical outcome of patients with a negative pulmonary DSA study was assessed by means of retrospective analysis of their medical records, with a minimum follow-up of 3 months. RESULTS: Among the 211 patients, DSA image quality was excellent in 129 (61.1%), adequate in 79 (37.4%), and poor in three (1.4%). Two angiograms (0.9%) were nondiagnostic. No complications occurred. Of 129 patients with negative DSA in whom anticoagulants were withheld, 16 died of disorders other than PE; one (0.9%, 95% confidence interval 0.0%, 4.2%) of 113 patients alive at 3 months returned after 3 weeks with possible PE. CONCLUSION: Pulmonary DSA with the flow-directed catheter is a safe procedure and provides good to excellent image quality. Anticoagulants can be withheld in patients suspected of having PE when pulmonary DSA results are negative.
PURPOSE: To evaluate image quality, safety, and clinical validity of selective, intraarterial, pulmonary digital subtraction angiography (DSA) with use of a flow-directed, balloon-tipped catheter in patients with suspected acute pulmonary embolism (PE). MATERIALS AND METHODS: Pulmonary DSA was performed in 211 patients with suspected PE. Subselective magnification series were obtained with nonionic contrast material. Clinical outcome of patients with a negative pulmonary DSA study was assessed by means of retrospective analysis of their medical records, with a minimum follow-up of 3 months. RESULTS: Among the 211 patients, DSA image quality was excellent in 129 (61.1%), adequate in 79 (37.4%), and poor in three (1.4%). Two angiograms (0.9%) were nondiagnostic. No complications occurred. Of 129 patients with negative DSA in whom anticoagulants were withheld, 16 died of disorders other than PE; one (0.9%, 95% confidence interval 0.0%, 4.2%) of 113 patients alive at 3 months returned after 3 weeks with possible PE. CONCLUSION: Pulmonary DSA with the flow-directed catheter is a safe procedure and provides good to excellent image quality. Anticoagulants can be withheld in patients suspected of having PE when pulmonary DSA results are negative.