Blood Pressure Reduction as an Aid to Renal Angiography in Hypertensive Patients
RENAL ANGIOGRAPHY is becoming an important technic in the diagnosis of hypertension of renal origin.1 However, satisfactory renal angiograms often are difficult to achieve in the presence of arterial hypertension. At high intra-aortic pressures, the injected contrast medium is diverted from the orifices of the renal arteries into the central aortic stream. This is primarily because high arterial pressure resists satisfactory occlusion of the iliac arteries by external compression, so that the medium does not pool in the aorta and disperse laterally. The resultant inadequacies in visualization cannot be safely overcome by the use of large doses of medium, since the possible nephrotoxic effects of contrast media2 are feared in patients with pre-existing renal disease, such as is common in hypertensive patients. However, temporary reduction of blood pressure with vasodepressor drugs permits satisfactory lateral streaming and facilitates iliac compression, so that adequate renal angiograms can be obtained with small volumes of injected medium. The present report describes the application of this principle in two cases.
TRANSLUMBAR AORTOGRAPHY AS USED FOR RENAL ANGIOGRAPHY3,4
The patient is given premedication to allay apprehension and discomfort and is placed prone on the roentgenographic table. A narrow, thick pad is placed under the lower abdomen for compression of the iliac arteries; a wide strap is then drawn snugly over the lumbosacral area. Novocain is injected into the area below the left twelfth rib and just lateral to the sacrospinalis muscle. The special aortogram needle is inserted into the aorta in the vicinity of the renal . . .